Healthcare Provider Details

I. General information

NPI: 1912249582
Provider Name (Legal Business Name): KIRSTEN JIRKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N. MILLER RD
FAIRLAWN OH
44333
UM

IV. Provider business mailing address

3569 FRANKLIN RD
STOW OH
44224-4020
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-2240
  • Fax:
Mailing address:
  • Phone: 330-310-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number05297
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: