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NPI Code Detail

MEDICARE: JENNIFER LEE CLELAND ATC

MEDICARE: JENNIFER LEE CLELAND ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1124351028
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LEE CLELAND ATC
Provider Business Mailing Address
First Line : 151 JANES WAY
Second Line :
City : WINCHESTER
State : VA
Zip : 22602-6666
Country : US
Telephone Number : 540-664-6384
Fax Number :
Provider Business Practice Location Address
First Line : 1420 AUSTIN BLUFFS PKWY
Second Line : UCCS SPORTS MEDICINE DEPT.
City : COLORADO SPRINGS
State : CO
Zip : 80918-3733
Country : US
Telephone Number : 719-255-4990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2009
Last Update Date : 09/09/2009

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