Provider Demographics
NPI:1841757754
Name:HOUSTON, JEFFREY
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2593
Mailing Address - Country:US
Mailing Address - Phone:330-498-8200
Mailing Address - Fax:
Practice Address - Street 1:FRAMER MOBILE HOME PARK
Practice Address - Street 2:LOT 4
Practice Address - City:CROOKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43731
Practice Address - Country:US
Practice Address - Phone:740-621-3519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.007396224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant