1063769024 NPI number — JENNA MARIE MAAG DPT

Table of content: JENNA MARIE MAAG DPT (NPI 1063769024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063769024 NPI number — JENNA MARIE MAAG DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAAG
Provider First Name:
JENNA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZEISLOFT
Provider Other First Name:
JENNA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063769024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7595 COUNTY ROAD 236
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FINDLAY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45840-8738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-427-1984
Provider Business Mailing Address Fax Number:
419-427-2524

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 565
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALIDA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45853-0565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-427-1984
Provider Business Practice Location Address Fax Number:
419-427-2524
Provider Enumeration Date:
08/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT013884 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0075387 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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