Provider Demographics
NPI:1265980296
Name:ELMORE, BRITTANY JACQUELYN (ATC)
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:JACQUELYN
Last Name:ELMORE
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 1:563 BERRYDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-1619
Mailing Address - Country:US
Mailing Address - Phone:541-670-0113
Mailing Address - Fax:
Practice Address - Street 1:655 N 3RD ST
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-1876
Practice Address - Country:US
Practice Address - Phone:541-630-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-101586222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer