Jeremy Marra, ATC,CSCS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2601000082 Issued in MI

Practice address

60 Averyville LN
Lake Placid, NY 12946-3002

Phone

(734) 502-6031

NPI assigned

Jul 9, 2007

Last updated

Dec 2, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669939200000",
    "number": "1447458799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 AVERYVILLE LN",
            "city": "LAKE PLACID",
            "state": "NY",
            "postal_code": "129463002",
            "telephone_number": "734-502-6031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 AVERYVILLE LN",
            "city": "LAKE PLACID",
            "state": "NY",
            "postal_code": "129463002",
            "telephone_number": "734-502-6031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27165 John Dr",
            "address_purpose": "LOCATION",
            "city": "New Boston",
            "state": "MI",
            "postal_code": "481649049",
            "country_code": "US",
            "telephone_number": "734-647-1921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARRA",
        "first_name": "JEREMY",
        "credential": "ATC,CSCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-09",
        "last_updated": "2022-12-02",
        "certification_date": "2022-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "2601000082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "multiple",
            "affiliation": "N",
            "address_1": "60 Averyville Ln",
            "city": "Lake Placid",
            "state": "NY",
            "country_code": "US",
            "postal_code": "129463002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Krista M Leblanc, LMHC, LPCC, LCMHC
• Colette Lettero
• Donald Peter Light, RPH
• Holli P Lynch, SPEECH AND HEARING
• Mara Lynn Mariani, DDS
• Brandon Matthews
• Woods McCahill, M.D.
• Katie McDowell, CF-SLP
• Crystal L McHugh, PT
• Dana Kaitlyn Megin, DPT

• Athletic Trainer in Lake Placid, NY
• Providers in Lake Placid, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.