Provider Demographics
NPI:1518263391
Name:JEWELL, DONALD (PTA LMT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:JEWELL
Suffix:
Gender:M
Credentials:PTA LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:ORANGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44453-0105
Mailing Address - Country:US
Mailing Address - Phone:330-246-0574
Mailing Address - Fax:
Practice Address - Street 1:7891 STATE ROUTE 609
Practice Address - Street 2:
Practice Address - City:ORANGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44453-0105
Practice Address - Country:US
Practice Address - Phone:330-246-0574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.008718225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist