Individual
JODEE M ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
813 ESHOM RD, CENTRALIA, WA 98531-1515
(360) 330-7605
Mailing address
19928 KUPER CT, CENTRALIA, WA 98531-9665
(509) 741-0414
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000014984
BOC CERTIFICATION NUMBER
WA
01
—
48449
NATA MEMBERSHIP NUMBER
—
Enumeration date
03/27/2018
Last updated
03/27/2018
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