Provider Demographics
NPI:1841387222
Name:RICHARDSON, JOLENE RENEE (MED,ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:RENEE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MED,ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 CAROLINE PARK LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1823
Mailing Address - Country:US
Mailing Address - Phone:281-353-9167
Mailing Address - Fax:
Practice Address - Street 1:13300 WILL CLAYTON PKWY
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346
Practice Address - Country:US
Practice Address - Phone:281-641-7681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT25912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer