Provider Demographics
NPI:1518151604
Name:BERRRY, JENNIFER MARYEE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARYEE
Last Name:BERRRY
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 1:1086 IRONGATE LN
Mailing Address - Street 2:APT B
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1086 IRONGATE LN
Practice Address - Street 2:APT B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4165
Practice Address - Country:US
Practice Address - Phone:614-579-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0028322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer