Provider Demographics
NPI:1407093859
Name:FARLEY, JEREMY (CPO, LPO)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:FARLEY
Suffix:
Gender:M
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 MILL RUN DRIVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43085
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3455 MILL RUN DRIVE
Practice Address - Street 2:SUITE 310
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43085
Practice Address - Country:US
Practice Address - Phone:855-694-5462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Z00000X, 225000000X
OHLPO306222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP 3518OtherAMERICAN BOARD OF CERTIFICATION IN PROSTHETIC AND ORTHOTICS