Provider Demographics
NPI:1356708531
Name:DRAKE, JORDAN AUSTIN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:AUSTIN
Last Name:DRAKE
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 1:2424 WINDING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1034
Mailing Address - Country:US
Mailing Address - Phone:419-376-2108
Mailing Address - Fax:
Practice Address - Street 1:2424 WINDING CREEK DR
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1034
Practice Address - Country:US
Practice Address - Phone:419-376-2108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer