Provider Demographics
NPI:1124184361
Name:GOTTSCHLING, JOANN M
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:M
Last Name:GOTTSCHLING
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 1:605 S TRIMBLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-4112
Mailing Address - Country:US
Mailing Address - Phone:419-756-0766
Mailing Address - Fax:419-756-4381
Practice Address - Street 1:605 S TRIMBLE RD STE A
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-4112
Practice Address - Country:US
Practice Address - Phone:419-756-0766
Practice Address - Fax:419-756-4381
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH371493170002OtherMEDICAL MUTUAL
OH000000340708OtherBLUE CROSS BLUE SHIELD
OH8297165OtherUNITED HEALTH CARE
OH2544125Medicaid
OH82010OtherNORTHWOOD NPN
OH82010OtherNORTHWOOD NPN