Basic Information
| Provider Information | |||||||||
| NPI: | 1609269786 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JEWETT | ||||||||
| FirstName: | BRANDY | ||||||||
| MiddleName: | NICOLE RAMAJ | ||||||||
| NamePrefix: | |||||||||
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| Credential: | ATC, LAT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | RAMAJ | ||||||||
| OtherFirstName: | BRANDY | ||||||||
| OtherMiddleName: | NICOLE | ||||||||
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| OtherCredential: | ATC, LAT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 701 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475018537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125845700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 933 S STATE ROAD 57 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475014374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122542203 | ||||||||
| FaxNumber: | 8122542033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2015 | ||||||||
| LastUpdateDate: | 06/07/2019 | ||||||||
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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 | 36002569A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.