Provider Demographics
NPI:1861860454
Name:CROWELL, JESSICA (ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CROWELL
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 1:120 MELLON AVE
Mailing Address - Street 2:
Mailing Address - City:PATTON
Mailing Address - State:PA
Mailing Address - Zip Code:16668-1731
Mailing Address - Country:US
Mailing Address - Phone:814-279-4857
Mailing Address - Fax:
Practice Address - Street 1:120 MELLON AVE
Practice Address - Street 2:
Practice Address - City:PATTON
Practice Address - State:PA
Practice Address - Zip Code:16668-1731
Practice Address - Country:US
Practice Address - Phone:814-279-4857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program