Provider Demographics
NPI:1851017362
Name:MAYLE, JERRY ALLEN
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:ALLEN
Last Name:MAYLE
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 1:1527 HARRISON AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-2525
Mailing Address - Country:US
Mailing Address - Phone:234-650-4044
Mailing Address - Fax:
Practice Address - Street 1:1527 HARRISON AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-2525
Practice Address - Country:US
Practice Address - Phone:234-650-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide