Individual
MRS. NICOLE JUSTINE FONTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
181 PATRICIA M GENOVA DR, NEWINGTON, CT 06111-1500
(860) 696-2500
(860) 696-2525
Mailing address
19 MEG WAY, WINDSOR LOCKS, CT 06096-1263
(860) 941-9744
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
663
CT
Other
Enumeration date
03/23/2020
Last updated
03/23/2020
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