Healthcare Provider Details

I. General information

NPI: 1740550375
Provider Name (Legal Business Name): JAMI L ROGERS MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMI L BEEBE MS, LAT, ATC

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 ROCKY CT
APPLETON WI
54915-2376
US

IV. Provider business mailing address

17 ROCKY CT
APPLETON WI
54915
US

V. Phone/Fax

Practice location:
  • Phone: 269-760-4943
  • Fax:
Mailing address:
  • Phone: 269-760-4943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1282-39
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: