Provider Demographics
NPI:1255692091
Name:ACHATZ, JESSICA DAWN (ATC, LAT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:ACHATZ
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 1:113 RIBBON LN APT M
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6887
Mailing Address - Country:US
Mailing Address - Phone:719-469-9608
Mailing Address - Fax:
Practice Address - Street 1:113 RIBBON LN APT M
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6887
Practice Address - Country:US
Practice Address - Phone:719-469-9608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2000003551OtherBOC
NC1761OtherNCBATE