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General NPI Number Information
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NPI Number | 1265980296
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Entity Type | Individual
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Provider Name | BRITTANY JACQUELYN ELMORE ATC
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Gender | Female
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 655 N 3RD ST
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City | CENTRAL POINT
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State | OR
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Zip | 97502-1876
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Country | US
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Telephone | 541-630-0705
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Fax |
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Provider Business Mailing Address
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Address Line | 563 BERRYDALE AVE
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City | MEDFORD
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State | OR
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Zip | 97501-1619
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Country | US
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Telephone | 541-670-0113
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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 | AT-AT-10158622
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License Number State | OR
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