Provider Demographics
NPI:1508957135
Name:WOODALL, JAMIE KAY (LAT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:KAY
Last Name:WOODALL
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 FRONT ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4003
Mailing Address - Country:US
Mailing Address - Phone:682-651-9028
Mailing Address - Fax:
Practice Address - Street 1:2118 WELSH AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-4867
Practice Address - Country:US
Practice Address - Phone:979-764-5536
Practice Address - Fax:979-764-5528
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT29612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer