Provider Demographics
NPI:1962658047
Name:PAXTON, JAY EDWARD (PTA)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:EDWARD
Last Name:PAXTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 QUARRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-9779
Mailing Address - Country:US
Mailing Address - Phone:724-588-5984
Mailing Address - Fax:
Practice Address - Street 1:AVRC 486 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:OH
Practice Address - Zip Code:44003
Practice Address - Country:US
Practice Address - Phone:440-293-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06144172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker