Healthcare Provider Details

I. General information

NPI: 1255090197
Provider Name (Legal Business Name): KERRIE JO SNYDER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 HARRISON AVE
ELKINS WV
26241-3497
US

IV. Provider business mailing address

1502 HARRISON AVE
ELKINS WV
26241-3497
US

V. Phone/Fax

Practice location:
  • Phone: 304-637-4509
  • Fax: 304-636-5319
Mailing address:
  • Phone: 304-637-4509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001226
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: