Provider Demographics
NPI:1992874853
Name:SPERGER, NICOLE SUZANNE (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SUZANNE
Last Name:SPERGER
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S FARMVIEW DR APT D15
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7701
Mailing Address - Country:US
Mailing Address - Phone:920-251-3727
Mailing Address - Fax:
Practice Address - Street 1:1200 N DUPONT HWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-2202
Practice Address - Country:US
Practice Address - Phone:302-857-7554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
JT0000623174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist