Provider Demographics
NPI:1992214860
Name:DESCHAINE, JENNIFER S (ATC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:DESCHAINE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:S
Other - Last Name:DODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11210 FARM RD 2222 APT 2302
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-0003
Mailing Address - Country:US
Mailing Address - Phone:210-724-2082
Mailing Address - Fax:
Practice Address - Street 1:11210 FARM RD 2222 APT 2302
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-0003
Practice Address - Country:US
Practice Address - Phone:210-724-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT41562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer