Provider Demographics
NPI:1215226923
Name:JIMISON, LAUREN ASHLEY (ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:ASHLEY
Last Name:JIMISON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SUMNER AVE
Mailing Address - Street 2:APARTMENT 5
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2342
Mailing Address - Country:US
Mailing Address - Phone:570-817-1607
Mailing Address - Fax:
Practice Address - Street 1:85 SUMNER AVE
Practice Address - Street 2:APARTMENT 5
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2342
Practice Address - Country:US
Practice Address - Phone:570-817-1607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA021152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer