NPI | 1639782907 |
---|---|
Former Name | JENNA OTTMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36003333A) |
Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: IN 36003333A) |
2083S0010X Preventive Medicine, Sports Medicine (Licence: IN 36003333A) | |
Enumeration Date | 2020-08-26 |
Last Update Date | 2021-01-06 |