Provider Demographics
NPI:1922077247
Name:SMITH, JAMIE LYNN (ATC)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LYNN
Last Name:SMITH
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 1:94 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-4139
Mailing Address - Country:US
Mailing Address - Phone:708-431-4732
Mailing Address - Fax:
Practice Address - Street 1:2499 E JOLIET HWY
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2592
Practice Address - Country:US
Practice Address - Phone:815-462-9420
Practice Address - Fax:815-462-9421
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer