| NPI | 1932455342 |
|---|---|
| Former Name | JESSICA MORIAH VANDERVEEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 1550) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT002093) |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2019-01-18 |