Provider Demographics
NPI:1417379009
Name:HARTIG, JESSICA (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:HARTIG
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 1:16 GLENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076-9086
Mailing Address - Country:US
Mailing Address - Phone:859-760-6191
Mailing Address - Fax:
Practice Address - Street 1:16 GLENRIDGE DR
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-9086
Practice Address - Country:US
Practice Address - Phone:859-760-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT3012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer