MEDICARE: JENNIFER A FOX

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	374U00000X	Home Health Aide	2424933	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2424933	OTHER	OH	INDEPENDENT PROVIDER

General Provider Information

NPI Number	:	1629295977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER A FOX

Provider Business Mailing Address
First Line	:	1252 18TH ST NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44703-1143
Country	:	US
Telephone Number	:	330-209-4555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1252 18TH ST NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44703-1143
Country	:	US
Telephone Number	:	330-209-4555
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/08/2007

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Directions to “ JENNIFER A FOX ” Practice Location

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