Healthcare Provider Details

I. General information

NPI: 1487565487
Provider Name (Legal Business Name): JACOB O'SHAY CONNOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 WOODLANDS DR STE 200
MAUMEE OH
43537-4045
US

IV. Provider business mailing address

PO BOX 823
PERRYSBURG OH
43552-0823
US

V. Phone/Fax

Practice location:
  • Phone: 419-491-0420
  • Fax:
Mailing address:
  • Phone: 419-491-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: