Healthcare Provider Details

I. General information

NPI: 1275380842
Provider Name (Legal Business Name): JILLIANE PUGH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3274 KENT RD STE 103
STOW OH
44224
US

IV. Provider business mailing address

3274 KENT RD STE 103
STOW OH
44224
US

V. Phone/Fax

Practice location:
  • Phone: 330-625-5911
  • Fax: 330-624-9326
Mailing address:
  • Phone: 330-625-5911
  • Fax: 330-624-9326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JILLIANE PUGH
Title or Position: OWNER
Credential:
Phone: 330-625-5911