Provider Demographics
NPI:1831555911
Name:GAVIN, JESSICA (ATC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GAVIN
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 1:1517 FOUNTAIN SQUARE DR APT 18B13
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4671
Mailing Address - Country:US
Mailing Address - Phone:330-718-0263
Mailing Address - Fax:
Practice Address - Street 1:3205 SWEETGUM TRL APT 1823
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2829
Practice Address - Country:US
Practice Address - Phone:330-718-0263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program