Provider Demographics
NPI:1881174878
Name:MUNSON, JAELA MARIE (ATC)
Entity type:Individual
Prefix:MRS
First Name:JAELA
Middle Name:MARIE
Last Name:MUNSON
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 1:306 KARL LINN DR APT 130
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-6985
Mailing Address - Country:US
Mailing Address - Phone:757-719-4436
Mailing Address - Fax:
Practice Address - Street 1:11501 OLD STAGE RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-2452
Practice Address - Country:US
Practice Address - Phone:804-638-8065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-19
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
VA01260037132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer