Provider Demographics
NPI:1609269786
Name:JEWETT, BRANDY NICOLE RAMAJ (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:NICOLE RAMAJ
Last Name:JEWETT
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:NICOLE
Other - Last Name:RAMAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:701 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-8537
Mailing Address - Country:US
Mailing Address - Phone:812-584-5700
Mailing Address - Fax:
Practice Address - Street 1:933 S STATE ROAD 57
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4374
Practice Address - Country:US
Practice Address - Phone:812-254-2203
Practice Address - Fax:812-254-2033
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002569A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer