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General NPI Number Information
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NPI Number | 1831656339
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Entity Type | Individual
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Provider Name | JACOB KEARY AT, ATC
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Gender | Male
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Dates
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Enumeration Date | 02/21/2019
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 799 N HEWITT RD
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City | YPSILANTI
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State | MI
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Zip | 48197-1701
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Country | US
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Telephone | 785-312-0294
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Fax |
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Provider Business Mailing Address
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Address Line | 2190 ARBOR CIR W APT 103
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City | YPSILANTI
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State | MI
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Zip | 48197-3453
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Country | US
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Telephone | 785-312-0294
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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 | 2601002465
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License Number State | MI
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