Individual
PAYTON MICHAEL JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
402 E VAN BUREN ST, OTTAWA, IL 61350-3603
(815) 830-8290
Mailing address
402 E VAN BUREN ST, OTTAWA, IL 61350-3603
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000028443
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/19/2016
Last updated
03/17/2018
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