Provider Demographics
NPI:1740842772
Name:REESE, JORDYN DANIELLE (ATC)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:DANIELLE
Last Name:REESE
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 1:5431 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-4490
Mailing Address - Country:US
Mailing Address - Phone:402-853-2796
Mailing Address - Fax:
Practice Address - Street 1:600 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2301
Practice Address - Country:US
Practice Address - Phone:918-456-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer