Basic Information
| Provider Information | |||||||||
| NPI: | 1558517706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLATZ | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ATC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FICHERA | ||||||||
| OtherFirstName: | JAMIE | ||||||||
| OtherMiddleName: | LYNN | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1342 FIELDSTONE DR | ||||||||
| Address2: | |||||||||
| City: | ORRVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446679063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129013969 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 832 S MAIN ST | ||||||||
| Address2: | DUNLAP COMMUNITY HOSPITAL | ||||||||
| City: | ORRVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446679527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306823010 | ||||||||
| FaxNumber: | 3306844742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2008 | ||||||||
| LastUpdateDate: | 08/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT002831 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.