Healthcare Provider Details

I. General information

NPI: 1962579755
Provider Name (Legal Business Name): JACQUELYNN HOPE DAVIS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 S MAIN ST SUITE 205
AKRON OH
44311-1064
US

IV. Provider business mailing address

1053 BURBANK AVE
AKRON OH
44305-1400
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-2110
  • Fax: 330-543-3851
Mailing address:
  • Phone: 330-697-8749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-2284
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: