Provider Demographics
NPI:1679584528
Name:SLEGEL, JAMIE WYNN (ATC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:WYNN
Last Name:SLEGEL
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 1:52-2 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3267
Mailing Address - Country:US
Mailing Address - Phone:610-987-4100
Mailing Address - Fax:
Practice Address - Street 1:17 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OLEY
Practice Address - State:PA
Practice Address - Zip Code:19547-8774
Practice Address - Country:US
Practice Address - Phone:610-987-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0033932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer