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General NPI Number Information
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NPI Number | 1588520688
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Entity Type | Individual
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Provider Name | JEREMY MAYNARD
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Gender | Male
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Dates
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Enumeration Date | 01/02/2026
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 8417 US ROUTE 60 STE 8
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-7662
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Country | US
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Telephone | 304-963-1964
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 109
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City | CEREDO
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State | WV
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Zip | 25507-0109
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Country | US
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Telephone | 304-963-1964
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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