Individual
JESSICA ZACCOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
4225 GENESEE ST, CHEEKTOWAGA, NY 14225-1994
(716) 204-3200
Mailing address
4225 GENESEE ST, CHEEKTOWAGA, NY 14225-1994
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
003021
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000020808
BOC ATC
—
01
—
56504
NATA
—
Enumeration date
08/13/2020
Last updated
08/13/2020
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