Provider Demographics
NPI:1831128024
Name:SPRINGSTEAD, JESSICA MARIE (MED, ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:MARIE
Last Name:SPRINGSTEAD
Suffix:
Gender:F
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RESERVOIR DR
Mailing Address - Street 2:
Mailing Address - City:WANAQUE
Mailing Address - State:NJ
Mailing Address - Zip Code:07465-2416
Mailing Address - Country:US
Mailing Address - Phone:973-632-4082
Mailing Address - Fax:908-497-7245
Practice Address - Street 1:201 W END PL
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-1850
Practice Address - Country:US
Practice Address - Phone:908-709-6968
Practice Address - Fax:908-497-1245
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001210002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer