Provider Demographics
NPI:1659414886
Name:RESCH, JAKE EARL (ATC)
Entity Type:Individual
Prefix:MR
First Name:JAKE
Middle Name:EARL
Last Name:RESCH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DAVIS ST APT B9
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5076
Mailing Address - Country:US
Mailing Address - Phone:706-614-5845
Mailing Address - Fax:
Practice Address - Street 1:101 DAVIS ST APT B9
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5076
Practice Address - Country:US
Practice Address - Phone:706-614-5845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD02292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer