Healthcare Provider Details

I. General information

NPI: 1336529122
Provider Name (Legal Business Name): JESSICA HOBGOOD ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CHADBOURNE LN
NORTH BERWICK ME
03906-5135
US

IV. Provider business mailing address

15 CHADBOURNE LN
NORTH BERWICK ME
03906-5135
US

V. Phone/Fax

Practice location:
  • Phone: 207-651-9571
  • Fax:
Mailing address:
  • Phone: 207-651-9571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT351
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: