Healthcare Provider Details

I. General information

NPI: 1508318106
Provider Name (Legal Business Name): JENNY MEIKLE SUMPTER-MAHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2016
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6357 CHURCHVIEW LN
WEST CHESTER OH
45069-1248
US

IV. Provider business mailing address

6357 CHURCHVIEW LN
WEST CHESTER OH
45069-1248
US

V. Phone/Fax

Practice location:
  • Phone: 513-593-2010
  • Fax:
Mailing address:
  • Phone: 513-593-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT005756
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: