MEDICARE: JEREMY TRIESLER JD(C), MALS, BSCJ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	344600000X	Taxi	94057667	OH

General Provider Information

NPI Number	:	1134900202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY TRIESLER JD(C), MALS, BSCJ

Provider Business Mailing Address
First Line	:	9318 LINCOLN WAY E
Second Line	:
City	:	ORRVILLE
State	:	OH
Zip	:	44667-9322
Country	:	US
Telephone Number	:	330-466-9885
Fax Number	:

Provider Business Practice Location Address
First Line	:	9318 LINCOLN WAY E
Second Line	:
City	:	ORRVILLE
State	:	OH
Zip	:	44667-9322
Country	:	US
Telephone Number	:	330-466-9885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2023
Last Update Date	:	10/22/2023

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