Provider Demographics
NPI:1972074508
Name:CREEM, JESSICA TESTANI (ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:TESTANI
Last Name:CREEM
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:TESTANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:20 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3722
Mailing Address - Country:US
Mailing Address - Phone:203-444-0039
Mailing Address - Fax:
Practice Address - Street 1:180 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1009
Practice Address - Country:US
Practice Address - Phone:860-236-5618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer