Healthcare Provider Details

I. General information

NPI: 1205267028
Provider Name (Legal Business Name): JILLIAN ROSE LAMAN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 MONTGOMERY RD
CINCINNATI OH
45236-2227
US

IV. Provider business mailing address

1926 RIVERWOOD TRL
KINGS MILLS OH
45034-9764
US

V. Phone/Fax

Practice location:
  • Phone: 513-246-2300
  • Fax:
Mailing address:
  • Phone: 513-307-8409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003767
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: