Provider Demographics
NPI:1013325570
Name:SPAUGH, JENNIFER (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SPAUGH
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6430 DORAL DR
Mailing Address - Street 2:
Mailing Address - City:TOBACCOVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27050-9557
Mailing Address - Country:US
Mailing Address - Phone:336-671-5786
Mailing Address - Fax:
Practice Address - Street 1:570 FORLINES RD
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8512
Practice Address - Country:US
Practice Address - Phone:336-671-5786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC392400282255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer