Provider Demographics
NPI:1386602928
Name:ADAMS, JACLYN MARIE (ATC)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARIE
Last Name:ADAMS
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 1:126 4TH STREET
Mailing Address - Street 2:POB 1084
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80520-1084
Mailing Address - Country:US
Mailing Address - Phone:303-918-3703
Mailing Address - Fax:
Practice Address - Street 1:311 MAPLETON AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3979
Practice Address - Country:US
Practice Address - Phone:303-544-5700
Practice Address - Fax:303-544-5710
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer