Provider Demographics
NPI:1992115992
Name:GELLER, NICHOLAS (ATC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:GELLER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:NICHOLAS
Other - Middle Name:
Other - Last Name:HOULNE-GELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1 DAYBROOK DR APT 314
Mailing Address - Street 2:
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-1730
Mailing Address - Country:US
Mailing Address - Phone:802-299-7257
Mailing Address - Fax:
Practice Address - Street 1:282 FARMERS ROW
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1848
Practice Address - Country:US
Practice Address - Phone:978-448-7532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer