Healthcare Provider Details

I. General information

NPI: 1922920081
Provider Name (Legal Business Name): JENNIFER M BEARDSLEE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WEEB EWBANK WAY
OXFORD OH
45056-3518
US

IV. Provider business mailing address

204 MORGAN CIR
OXFORD OH
45056-9403
US

V. Phone/Fax

Practice location:
  • Phone: 513-529-4777
  • Fax:
Mailing address:
  • Phone: 513-330-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001084
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: