Provider Demographics
NPI:1467905620
Name:PIERCE, JESSICA (MS, LAT, ATC, CES)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:MS, LAT, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 MOUNTAIN CREEK RD
Mailing Address - Street 2:APT 201
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-6731
Mailing Address - Country:US
Mailing Address - Phone:256-777-5194
Mailing Address - Fax:
Practice Address - Street 1:615 MCCALLIE AVE DEPT 3503
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2504
Practice Address - Country:US
Practice Address - Phone:423-425-2803
Practice Address - Fax:423-425-5436
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer