Provider Demographics
NPI:1083747844
Name:PITSON, JENNIFER M (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:PITSON
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 CAMERON LN
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2902
Mailing Address - Country:US
Mailing Address - Phone:419-226-9019
Mailing Address - Fax:419-226-9244
Practice Address - Street 1:830 W HIGH ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-3971
Practice Address - Country:US
Practice Address - Phone:419-226-9019
Practice Address - Fax:419-226-9244
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH24072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer