Healthcare Provider Details

I. General information

NPI: 1114822350
Provider Name (Legal Business Name): JESSICA MAE MATERNI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6544 W CENTRAL AVE STE A
TOLEDO OH
43617-1031
US

IV. Provider business mailing address

29456 PEMBERVILLE RD
MILLBURY OH
43447-9740
US

V. Phone/Fax

Practice location:
  • Phone: 419-517-1332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA009043
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: