Provider Demographics
NPI:1558805622
Name:RICKER, JAMIE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:
Last Name:RICKER
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 1:2 HAWTHORNE WOODS APT C
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2962
Mailing Address - Country:US
Mailing Address - Phone:856-562-1180
Mailing Address - Fax:
Practice Address - Street 1:401 KINGS HWY E
Practice Address - Street 2:ATTN: ATHLETIC TRAINER
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1206
Practice Address - Country:US
Practice Address - Phone:856-429-3960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002011002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer