Provider Demographics
NPI:1770521890
Name:JONES-WILLIS, LAURA LEA (ATC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEA
Last Name:JONES-WILLIS
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 1:2382 NW GRENFELL LOOP
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6655
Mailing Address - Country:US
Mailing Address - Phone:503-857-0167
Mailing Address - Fax:
Practice Address - Street 1:2382 NW GRENFELL LOOP
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6655
Practice Address - Country:US
Practice Address - Phone:503-857-0167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2255A2300XOtherATHLETIC TRAINER