Healthcare Provider Details

I. General information

NPI: 1982934725
Provider Name (Legal Business Name): JESSICA KEMPA ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 BARREN RD
MEDIA PA
19063-4505
US

IV. Provider business mailing address

7919 35TH ST
BALTIMORE MD
21237-1409
US

V. Phone/Fax

Practice location:
  • Phone: 610-627-6233
  • Fax:
Mailing address:
  • Phone: 410-866-9597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT004328
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: