Individual
JESSICA GAITHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 MAIN ST, PECATONICA, IL 61063-9440
(815) 239-2611
Mailing address
2780 SANDHUTTON AVE APT 8, ROCKFORD, IL 61109-7542
(618) 246-0323
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096004749
IL
Other
Enumeration date
12/05/2018
Last updated
12/05/2018
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