Individual
JAMIE DESTACHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2050 4TH AVE, STEVENS POINT, WI 54481-1910
(262) 527-5200
Mailing address
1910 COLUMBIA ST, EUGENE, OR 97403-1440
(262) 527-5200
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/27/2015
Last updated
08/08/2016
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