Provider Demographics
NPI:1134428410
Name:SCAMEHORN, JENNIFER (LAT, ATC)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:SCAMEHORN
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 W ARCH HAVEN AVE
Mailing Address - Street 2:BLDG 1320 SUITE E
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2089
Mailing Address - Country:US
Mailing Address - Phone:231-342-6970
Mailing Address - Fax:812-336-8342
Practice Address - Street 1:3901 N KINSER PIKE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-1870
Practice Address - Country:US
Practice Address - Phone:231-342-6970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002554A2255A2300X
NV05063052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer