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General NPI Number Information
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NPI Number | 1912332487
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Entity Type | Individual
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Provider Name | JILLIAN MARIE SEAMON A.T.C.
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Gender | Female
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 200 PROSPECT ST KOEHLER FIELD HOUSE
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-2956
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Country | US
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Telephone | 570-579-8230
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Fax |
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Provider Business Mailing Address
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Address Line | 1722 EVERGREEN DR
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City | HAZLE TOWNSHIP
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State | PA
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Zip | 18202-9468
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Country | US
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Telephone | 570-579-8230
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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 | 25MT00189500
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License Number State | NJ
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