Healthcare Provider Details

I. General information

NPI: 1710801089
Provider Name (Legal Business Name): JACQUELINE MARIE ABBOTT CPRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3539 HILTON ST NW
MASSILLON OH
44646-3122
US

IV. Provider business mailing address

3539 HILTON ST NW
MASSILLON OH
44646-3122
US

V. Phone/Fax

Practice location:
  • Phone: 330-639-3455
  • Fax:
Mailing address:
  • Phone: 330-639-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.006714
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: