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General NPI Number Information
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NPI Number | 1346870789
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Entity Type | Individual
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Provider Name | JENNIFER MAYBRY ATC
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Gender | Female
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 102 IRVING ST NW
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City | WASHINGTON
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State | DC
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Zip | 20010-2921
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Country | US
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Telephone | 573-587-9805
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Fax |
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Provider Business Mailing Address
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Address Line | 8010 GRAMERCY BLVD APT 501
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City | DERWOOD
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State | MD
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Zip | 20855-2371
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Country | US
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Telephone |
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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 | 0126002768
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | A0000125
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License Number State | MD
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