Individual
MS. JESSICA LEE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
134 N ROSE ST, BALTIMORE, MD 21224-1152
(419) 708-6875
Mailing address
134 N ROSE ST, BALTIMORE, MD 21224-1152
(419) 708-6875
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
A00797
MD
2255A2300X
Athletic Trainer
AT.004256
OH
Other
Enumeration date
09/21/2016
Last updated
09/21/2016
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