Provider Demographics
NPI:1922500263
Name:GRAF, JENNIFER MAE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAE
Last Name:GRAF
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 CHESTNUT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21915-1114
Mailing Address - Country:US
Mailing Address - Phone:817-504-6785
Mailing Address - Fax:
Practice Address - Street 1:2755 AUGUSTINE HERMAN HWY # MD21915
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE CITY
Practice Address - State:MD
Practice Address - Zip Code:21915-1408
Practice Address - Country:US
Practice Address - Phone:410-885-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00001192255A2300X
0308020642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer