Provider Demographics
NPI:1831308345
Name:GILLETTE, JESSICA FAYE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:FAYE
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 E 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1606
Mailing Address - Country:US
Mailing Address - Phone:620-245-4696
Mailing Address - Fax:
Practice Address - Street 1:1200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-5740
Practice Address - Country:US
Practice Address - Phone:620-241-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS005152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer