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General NPI Number Information
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NPI Number | 1770792277
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Entity Type | Individual
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Provider Name | JARRETT R AUSTIN MS, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 301 S BRYANT AVE STE B-100
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City | EDMOND
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State | OK
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Zip | 73034-5790
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Country | US
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Telephone | 405-340-2019
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Fax |
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Provider Business Mailing Address
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Address Line | 13508 PECAN PL
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City | EDMOND
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State | OK
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Zip | 73013-5614
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Country | US
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Telephone | 405-475-0466
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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 | 452
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License Number State | OK
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