Healthcare Provider Details

I. General information

NPI: 1578002895
Provider Name (Legal Business Name): CARLEE MARIE JONES ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 MIDDLE URBANA RD
SPRINGFIELD OH
45503-6306
US

IV. Provider business mailing address

10034B GREENBUSH RD
CAMDEN OH
45311-9705
US

V. Phone/Fax

Practice location:
  • Phone: 513-283-5408
  • Fax:
Mailing address:
  • Phone: 513-283-5408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT006548
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: