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General NPI Number Information
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NPI Number | 1093206047
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Entity Type | Individual
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Provider Name | JASON LEE WOODARD
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Gender | Male
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Dates
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Enumeration Date | 05/25/2018
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Last Update Date | 05/25/2018
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Provider Practice Location Address
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Address Line | 2649 NORTHWOOD AVE
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City | TOLEDO
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State | OH
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Zip | 43606-3707
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Country | US
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Telephone | 567-395-7699
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Fax |
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Provider Business Mailing Address
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Address Line | 5702 ANGOLA RD LOT 190
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City | TOLEDO
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State | OH
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Zip | 43615-6360
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Country | US
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Telephone | 567-395-7699
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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