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NPI Code Detail

MEDICARE: MRS. JAMIE LYNN CLAYBROOKS ATC/L

MEDICARE: MRS. JAMIE LYNN CLAYBROOKS ATC/L
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 Trainer36001033AIN

General Provider Information

NPI Number : 1881650265
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JAMIE LYNN CLAYBROOKS ATC/L
Provider Business Mailing Address
First Line : 533 W COLUMBIA ST
Second Line :
City : EVANSVILLE
State : IN
Zip : 47710-1617
Country : US
Telephone Number : 812-424-9291
Fax Number : 812-421-2722
Provider Business Practice Location Address
First Line : 533 W COLUMBIA ST
Second Line :
City : EVANSVILLE
State : IN
Zip : 47710-1617
Country : US
Telephone Number : 812-424-9291
Fax Number : 812-421-2722
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 04/08/2010

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