MEDICARE: JACQUELINE MARIE PROCTOR

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	376J00000X	Homemaker		OH

General Provider Information

NPI Number	:	1578165361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE MARIE PROCTOR

Provider Business Mailing Address
First Line	:	1141 MILTON ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-2126
Country	:	US
Telephone Number	:	234-788-3665
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 MILTON ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-2126
Country	:	US
Telephone Number	:	234-788-3665
Fax Number	:

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

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	11/16/2020

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Directions to “ JACQUELINE MARIE PROCTOR ” Practice Location

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