Provider Demographics
NPI:1679061154
Name:FARRELL, JAMIE ANN (OCPSRA)
Entity Type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:ANN
Last Name:FARRELL
Suffix:
Gender:F
Credentials:OCPSRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 CARLIN ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1460
Mailing Address - Country:US
Mailing Address - Phone:419-422-8616
Mailing Address - Fax:
Practice Address - Street 1:1941 CARLIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1460
Practice Address - Country:US
Practice Address - Phone:419-422-8616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341475943Medicaid