Provider Demographics
NPI:1215601455
Name:JEWETT SPORTS & OCCUPATIONAL HEALTH
Entity Type:Organization
Organization Name:JEWETT SPORTS & OCCUPATIONAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINER / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:NICOLE RAMAJ
Authorized Official - Last Name:JEWETT
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:812-584-5700
Mailing Address - Street 1:PO BOX 2302
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-0942
Mailing Address - Country:US
Mailing Address - Phone:812-584-5700
Mailing Address - Fax:
Practice Address - Street 1:701 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-8537
Practice Address - Country:US
Practice Address - Phone:812-584-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty