Provider Demographics
NPI:1982739348
Name:EMERSON, JEANETTE LANE (ATC , PTA,)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:LANE
Last Name:EMERSON
Suffix:
Gender:F
Credentials:ATC , PTA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HUCKLEBERRY RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1055
Mailing Address - Country:US
Mailing Address - Phone:508-497-2427
Mailing Address - Fax:
Practice Address - Street 1:8 HUCKLEBERRY RD
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-1055
Practice Address - Country:US
Practice Address - Phone:508-497-2427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer