Healthcare Provider Details

I. General information

NPI: 1942729009
Provider Name (Legal Business Name): JENNIFER LYNN MOYER DEM, DOULA, L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LYNN REEDY L.M.T.

II. Dates (important events)

Enumeration Date: 09/10/2017
Last Update Date: 09/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2328 TOWNLEY RD
TOLEDO OH
43614-4338
US

IV. Provider business mailing address

21552 ROAD I21
CLOVERDALE OH
45827-9593
US

V. Phone/Fax

Practice location:
  • Phone: 419-356-4722
  • Fax: 419-356-4722
Mailing address:
  • Phone: 567-376-5262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33-012618
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: