Provider Demographics
NPI:1144432089
Name:PRICE, JESSICA EMILY (ATC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:EMILY
Last Name:PRICE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5879 CAPE CORAL LN
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9791
Mailing Address - Country:US
Mailing Address - Phone:614-319-4157
Mailing Address - Fax:
Practice Address - Street 1:3148 BROADWAY
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-1781
Practice Address - Country:US
Practice Address - Phone:614-539-4646
Practice Address - Fax:614-539-4666
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0023972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer