Healthcare Provider Details

I. General information

NPI: 1619836111
Provider Name (Legal Business Name): JASON ROBERT MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 OUTLOOK DR
SILVER LAKE OH
44224-3721
US

IV. Provider business mailing address

1528 HYDE PARK AVE
AKRON OH
44310-2629
US

V. Phone/Fax

Practice location:
  • Phone: 330-786-7603
  • Fax:
Mailing address:
  • Phone: 330-786-7603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberRT810124
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: