Individual
MISS JENNIFER MARAGRET MCCAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
335 E LEWIS ST STE 10, POCATELLO, ID 83201-6408
(208) 269-2360
Mailing address
335 E LEWIS ST STE 10, POCATELLO, ID 83201-6408
(208) 269-2360
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000038812
ATHLETIC TRAINING BOARD OF CERTIFICATION
—
Enumeration date
03/27/2019
Last updated
07/14/2020
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