Provider Demographics
NPI:1225774623
Name:MAILHIOT, JENNIFER (ATC LAT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MAILHIOT
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 1:194 WALLUM LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516-2516
Mailing Address - Country:US
Mailing Address - Phone:774-280-2673
Mailing Address - Fax:
Practice Address - Street 1:375 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-4124
Practice Address - Country:US
Practice Address - Phone:774-280-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer