Provider Demographics
NPI:1891961942
Name:STREU, JESSICA SARA (ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SARA
Last Name:STREU
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 1:2299 OLD BACONE RD
Mailing Address - Street 2:BACONE COLLEGE ATHLETICS
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-1568
Mailing Address - Country:US
Mailing Address - Phone:918-685-0809
Mailing Address - Fax:
Practice Address - Street 1:2299 OLD BACONE RD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1568
Practice Address - Country:US
Practice Address - Phone:918-685-0809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer