Provider Demographics
NPI:1104470806
Name:KOMAREK, JACQUELINE MARIE (ATC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARIE
Last Name:KOMAREK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 RAHLING RD APT 408
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4651
Mailing Address - Country:US
Mailing Address - Phone:501-317-7348
Mailing Address - Fax:
Practice Address - Street 1:7507 WARDEN RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5042
Practice Address - Country:US
Practice Address - Phone:501-301-4530
Practice Address - Fax:501-251-1165
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer