Timothy Steven Nicolello, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

400 Issued in ID

Practice address

1109 W Myrtle St
Suite 200
Boise, ID 83702-6970

Phone

(208) 874-3449

NPI assigned

Oct 31, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333324800000",
    "number": "1831475284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14078 W BUNKERHILL ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130702",
            "telephone_number": "208-874-3449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 W MYRTLE ST",
            "address_2": "SUITE 200",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026970",
            "telephone_number": "208-874-3449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLELLO",
        "first_name": "TIMOTHY",
        "middle_name": "STEVEN",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-31",
        "last_updated": "2012-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other",
            "state": "ID",
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ID",
            "license": "400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marissa Nickel, LCSW
• Nicole Nickell, OT
• Douglas W Nicolarsen
• Nicole Berenger Counseling LLC
• Nicole Thurston, M.D., PLLC
• Karissa I Niece
• Matt Niece, LPC
• Blake D Niederhauser, MD
• Alexandra Marie Nielsen, RN, NP
• Alyson Nielsen I

• Athletic Trainer in Boise, ID
• Providers in Boise, ID by specialty
• Athletic Trainer in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.