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General NPI Number Information
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NPI Number | 1174828339
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Entity Type | Individual
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Provider Name | JENNIFER A KEOUGH ATC
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Gender | Female
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Dates
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Enumeration Date | 01/20/2011
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | TEAGLE HALL, CAMPUS RD CORNELL UNIVERSITY
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City | ITHACA
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State | NY
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Zip | 14853
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Country | US
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Telephone | 607-255-4237
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Fax |
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Provider Business Mailing Address
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Address Line | 121 ELLERY RD
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City | ROCHESTER
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State | NY
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Zip | 14612-2978
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Country | US
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Telephone | 585-227-2231
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001958
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License Number State | NY
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