Provider Demographics
NPI:1770548018
Name:COLLINS, JENNIFER DIANE (ATC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DIANE
Last Name:COLLINS
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 1:25 MARSTON ST
Mailing Address - Street 2:APT 301
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6170
Mailing Address - Country:US
Mailing Address - Phone:207-577-0780
Mailing Address - Fax:
Practice Address - Street 1:130 CENTRAL AVE
Practice Address - Street 2:BATES COLLEGE DEPARTMENT OF ATHLETICS
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6042
Practice Address - Country:US
Practice Address - Phone:207-786-8258
Practice Address - Fax:207-755-5959
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT2662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer