Provider Demographics
NPI:1922582238
Name:JAKLITSCH, TAMARA E
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:E
Last Name:JAKLITSCH
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 1:900 INDIAN HILL DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8536
Mailing Address - Country:US
Mailing Address - Phone:308-696-3443
Mailing Address - Fax:330-869-6366
Practice Address - Street 1:900 INDIAN HILL DR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8536
Practice Address - Country:US
Practice Address - Phone:308-696-3443
Practice Address - Fax:330-869-6366
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies