Provider Demographics
NPI:1407904436
Name:ANDREW, JENNIFER ANN I (ATC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:ANDREW
Suffix:I
Gender:F
Credentials:ATC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6506 CHIPPEWA TR.
Mailing Address - Street 2:PO BOX 1007
Mailing Address - City:INDIAN RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49749
Mailing Address - Country:US
Mailing Address - Phone:231-238-9231
Mailing Address - Fax:231-238-8777
Practice Address - Street 1:3805 S. SRAITS HWY.
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749
Practice Address - Country:US
Practice Address - Phone:231-238-4880
Practice Address - Fax:231-238-8777
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer