Provider Demographics
NPI:1013324516
Name:IVER, JESSICA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:IVER
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 1:119 WATSON PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1962
Mailing Address - Country:US
Mailing Address - Phone:314-961-3787
Mailing Address - Fax:314-961-0974
Practice Address - Street 1:119 WATSON PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1962
Practice Address - Country:US
Practice Address - Phone:314-961-3787
Practice Address - Fax:314-961-0974
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20000003972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer