Healthcare Provider Details

I. General information

NPI: 1679584528
Provider Name (Legal Business Name): JAMIE WYNN SLEGEL ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 JEFFERSON ST
OLEY PA
19547-8774
US

IV. Provider business mailing address

52-2 HOLLY DR
READING PA
19606-3267
US

V. Phone/Fax

Practice location:
  • Phone: 610-987-4100
  • Fax:
Mailing address:
  • Phone: 610-987-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT003393
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: