MEDICARE: JAKSON HENRY MEYER ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer		WI

General Provider Information

NPI Number	:	1871306886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAKSON HENRY MEYER ATC

Provider Business Mailing Address
First Line	:	3340 N 13TH ST
Second Line	:
City	:	WAUSAU
State	:	WI
Zip	:	54403-2318
Country	:	US
Telephone Number	:	715-680-6048
Fax Number	:

Provider Business Practice Location Address
First Line	:	3340 N 13TH ST
Second Line	:
City	:	WAUSAU
State	:	WI
Zip	:	54403-2318
Country	:	US
Telephone Number	:	715-680-6048
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	05/22/2026

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