Provider Demographics
NPI:1730285859
Name:GARRARD, JENNIFER D (ATC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:D
Last Name:GARRARD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:D
Other - Last Name:HERMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:5000 DEER PARK DR SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-9392
Mailing Address - Country:US
Mailing Address - Phone:503-589-8160
Mailing Address - Fax:503-315-2941
Practice Address - Street 1:5000 DEER PARK DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-9392
Practice Address - Country:US
Practice Address - Phone:503-589-8160
Practice Address - Fax:503-315-2941
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-10069072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer