Provider Demographics
NPI:1205808797
Name:KORN, JESSICA R (ATC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:KORN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MARSHALL ST
Mailing Address - Street 2:#3
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3326
Mailing Address - Country:US
Mailing Address - Phone:610-842-6972
Mailing Address - Fax:
Practice Address - Street 1:445 MANOR AVE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2544
Practice Address - Country:US
Practice Address - Phone:610-269-4400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0034022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer