Provider Demographics
NPI:1396873691
Name:SARGENT, JENNIFER AMY (ATC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:AMY
Last Name:SARGENT
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 1:49 SAINT JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3031
Mailing Address - Country:US
Mailing Address - Phone:860-741-5984
Mailing Address - Fax:
Practice Address - Street 1:76 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06088-9741
Practice Address - Country:US
Practice Address - Phone:860-627-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer