Provider Demographics
NPI:1780938282
Name:SNELL, JACQUELINE CLOUSE (ATC)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:CLOUSE
Last Name:SNELL
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 1:5414 COUGAR TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-3841
Mailing Address - Country:US
Mailing Address - Phone:540-440-0423
Mailing Address - Fax:
Practice Address - Street 1:5414 COUGAR TRAIL RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3841
Practice Address - Country:US
Practice Address - Phone:540-440-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260001692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer