Provider Demographics
NPI:1336282755
Name:WITTING, JENNIFER LYNN (MS, ATC, OTC)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LYNN
Last Name:WITTING
Suffix:
Gender:F
Credentials:MS, ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:280 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ALLOUEZ
Mailing Address - State:MI
Mailing Address - Zip Code:49805-6918
Mailing Address - Country:US
Mailing Address - Phone:906-337-6585
Mailing Address - Fax:906-337-6573
Practice Address - Street 1:205 OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:LAURIUM
Practice Address - State:MI
Practice Address - Zip Code:49913-2134
Practice Address - Country:US
Practice Address - Phone:906-337-6585
Practice Address - Fax:906-337-6573
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MI07-0815246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other