MEDICARE: JAYLA M BALBAUGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		OH

General Provider Information

NPI Number	:	1306658885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYLA M BALBAUGH

Provider Business Mailing Address
First Line	:	10030 ROAD 13
Second Line	:
City	:	OTTAWA
State	:	OH
Zip	:	45875-9464
Country	:	US
Telephone Number	:	419-796-7128
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 ARLINGTON AVE BLDG MS 1027
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2595
Country	:	US
Telephone Number	:	419-530-5408
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	02/05/2026

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