Provider Demographics
NPI:1336685254
Name:SCHARRINGHAUSEN, JACQUELYN (PTA)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:SCHARRINGHAUSEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 AVALON RD
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-1201
Mailing Address - Country:US
Mailing Address - Phone:419-971-0008
Mailing Address - Fax:
Practice Address - Street 1:818 AVALON RD
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-1201
Practice Address - Country:US
Practice Address - Phone:419-971-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA011072225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant