Provider Demographics
NPI:1679190185
Name:SCHIMMEL, JEREMY RYAN (ATC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:RYAN
Last Name:SCHIMMEL
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 1:7705 STONE WHEAT CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3709
Mailing Address - Country:US
Mailing Address - Phone:703-624-0595
Mailing Address - Fax:
Practice Address - Street 1:271 PINE NOOK RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01342-9746
Practice Address - Country:US
Practice Address - Phone:413-774-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer