Provider Demographics
NPI:1114425394
Name:MITCHELL, JUSTINE M
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1484 COUNTY ROAD 80
Mailing Address - Street 2:
Mailing Address - City:ALGER
Mailing Address - State:OH
Mailing Address - Zip Code:45812-9646
Mailing Address - Country:US
Mailing Address - Phone:567-525-2155
Mailing Address - Fax:
Practice Address - Street 1:1484 COUNTY ROAD 80
Practice Address - Street 2:
Practice Address - City:ALGER
Practice Address - State:OH
Practice Address - Zip Code:45812-9646
Practice Address - Country:US
Practice Address - Phone:567-525-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer