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General NPI Number Information
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NPI Number | 1174950349
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Entity Type | Individual
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Provider Name | JAIME A WIRTH CO
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Gender | Female
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 3700 BRAINERD RD
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City | CHATTANOOGA
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State | TN
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Zip | 37411-3603
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Country | US
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Telephone | 423-697-0057
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Fax | 423-648-9366
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Provider Business Mailing Address
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Address Line | 3700 BRAINERD RD
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City | CHATTANOOGA
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State | TN
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Zip | 37411-3603
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Country | US
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Telephone | 423-697-0057
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Fax | 423-648-9366
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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 | 222Z00000X
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Taxonomy Name | Orthotist
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License Number |
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License Number State |
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