Individual
KAULA JACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
600 DARES BEACH RD, PRINCE FREDERICK, MD 20678-4200
(410) 610-7718
Mailing address
8501 BAYSIDE RD UNIT C4, CHESAPEAKE BEACH, MD 20732-3313
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
A0000893
MD
Other
Enumeration date
09/20/2016
Last updated
09/21/2016
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