Provider Demographics
NPI:1962579755
Name:DAVIS, JACQUELYNN HOPE (ATC)
Entity type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:HOPE
Last Name:DAVIS
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 1:1053 BURBANK AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-1400
Mailing Address - Country:US
Mailing Address - Phone:330-697-8749
Mailing Address - Fax:
Practice Address - Street 1:388 S MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1064
Practice Address - Country:US
Practice Address - Phone:330-543-2110
Practice Address - Fax:330-543-3851
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-22842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer