Provider Demographics
NPI:1245646207
Name:KAUFFMAN, JEREMY (MS, ATC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:KAUFFMAN
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLLEGE AVE STE 4501
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-6815
Mailing Address - Country:US
Mailing Address - Phone:717-766-2511
Mailing Address - Fax:717-796-5229
Practice Address - Street 1:1 COLLEGE AVE STE 4501
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-6815
Practice Address - Country:US
Practice Address - Phone:717-766-2511
Practice Address - Fax:717-796-5229
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0033962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer