Healthcare Provider Details

I. General information

NPI: 1568299535
Provider Name (Legal Business Name): JASMINE WILLIAMS LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 PEARL ST
FITCHBURG MA
01420-2631
US

IV. Provider business mailing address

175 POOR FARM RD
NEW IPSWICH NH
03071-3926
US

V. Phone/Fax

Practice location:
  • Phone: 978-665-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1624
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: