Provider Demographics
NPI:1992848337
Name:ATKINS, JEREMY DANIEL (ATC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:DANIEL
Last Name:ATKINS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12853 DIXIE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2601
Mailing Address - Country:US
Mailing Address - Phone:248-763-1432
Mailing Address - Fax:
Practice Address - Street 1:1600 E OAKLEY PARK RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-5509
Practice Address - Country:US
Practice Address - Phone:248-672-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer