Provider Demographics
NPI:1639296692
Name:RATTAI-SHEPARD, JILL MEREDITH
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MEREDITH
Last Name:RATTAI-SHEPARD
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 1:1596 OLYMPUS DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4630
Mailing Address - Country:US
Mailing Address - Phone:330-673-3134
Mailing Address - Fax:
Practice Address - Street 1:1596 OLYMPUS DR
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4630
Practice Address - Country:US
Practice Address - Phone:330-673-3134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2111922374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2111922Medicaid