Healthcare Provider Details

I. General information

NPI: 1184530198
Provider Name (Legal Business Name): JORDAN MANLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ROTHROCK LOOP
COPLEY OH
44321-1331
US

IV. Provider business mailing address

13559 KAUFMAN AVE NW
HARTVILLE OH
44632-9042
US

V. Phone/Fax

Practice location:
  • Phone: 330-666-2228
  • Fax:
Mailing address:
  • Phone: 330-639-8549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number008648
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: