Provider Demographics
NPI:1750805719
Name:WOODS, JENNIFER ANN (ATC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:WOODS
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 1:502 E 12TH AVE APT S15
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-7007
Mailing Address - Country:US
Mailing Address - Phone:815-355-9865
Mailing Address - Fax:
Practice Address - Street 1:1 KELLOGG CIR
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-5415
Practice Address - Country:US
Practice Address - Phone:620-341-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-011512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer