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General NPI Number Information
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NPI Number | 1689635617
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Entity Type | Individual
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Provider Name | JILLIAN LEE WITHINGTON MS,ATC,CSCS
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Gender | Female
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8 ABBOTT PARK PL
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City | PROVIDENCE
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State | RI
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Zip | 02903-3703
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Country | US
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Telephone | 401-598-1631
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Fax |
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Provider Business Mailing Address
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Address Line | 98 MAJESTIC AVE
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City | WARWICK
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State | RI
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Zip | 02888-2359
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Country | US
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Telephone | 401-781-4273
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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 | AT00165
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License Number State | RI
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