Healthcare Provider Details

I. General information

NPI: 1396334827
Provider Name (Legal Business Name): JEREMY R FLOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 FRAZEYSBURG RD
NASHPORT OH
43830-9090
US

IV. Provider business mailing address

6115 FRAZEYSBURG RD
NASHPORT OH
43830-9090
US

V. Phone/Fax

Practice location:
  • Phone: 740-252-6431
  • Fax:
Mailing address:
  • Phone: 740-252-6431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: