Provider Demographics
NPI:1295460921
Name:WOHL, JACINTA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:JACINTA
Middle Name:MARIE
Last Name:WOHL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 STONECREEK DR S STE 101
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9853
Mailing Address - Country:US
Mailing Address - Phone:614-604-6358
Mailing Address - Fax:
Practice Address - Street 1:1501 STONECREEK DR S STE 101
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9853
Practice Address - Country:US
Practice Address - Phone:614-604-6358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.024974225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist