Healthcare Provider Details

I. General information

NPI: 1609806850
Provider Name (Legal Business Name): JENNIFER DAWN RICHARDSON ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W BROOKS ST
NORMAN OK
73019-1018
US

IV. Provider business mailing address

616 SUMMIT BND
NORMAN OK
73071-0608
US

V. Phone/Fax

Practice location:
  • Phone: 405-325-0368
  • Fax: 405-325-8388
Mailing address:
  • Phone: 405-325-0368
  • Fax: 405-325-8388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT000929
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: