Provider Demographics
NPI:1730303785
Name:VEENSTRA, JAMIE MARIE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:MARIE
Last Name:VEENSTRA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4114 HATHAWAY AVE
Mailing Address - Street 2:APT. #3
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-2619
Mailing Address - Country:US
Mailing Address - Phone:562-706-4843
Mailing Address - Fax:
Practice Address - Street 1:4226 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3511
Practice Address - Country:US
Practice Address - Phone:562-431-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer