Provider Demographics
NPI:1487643490
Name:FREESE, JENNIFER JOHNSON (ATC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JOHNSON
Last Name:FREESE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CLARENDON TER
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3609
Mailing Address - Country:US
Mailing Address - Phone:860-204-3476
Mailing Address - Fax:
Practice Address - Street 1:166 ALBANY TPKE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2546
Practice Address - Country:US
Practice Address - Phone:860-693-8835
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer