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General NPI Number Information
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NPI Number | 1518498542
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Entity Type | Individual
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Provider Name | JACQUELYN MICHELLE RODGERS
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Gender | Female
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 2474 TULANE ST
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City | WEST LINN
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State | OR
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Zip | 97068-2434
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Country | US
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Telephone | 541-992-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 2474 TULANE ST
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City | WEST LINN
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State | OR
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Zip | 97068-2434
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Country | US
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Telephone | 541-992-6100
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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 | 1455178
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License Number State | OR
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