Provider Demographics
NPI:1477829208
Name:SUFFEL, JENA R (DHSC, AT, CSCS)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:R
Last Name:SUFFEL
Suffix:
Gender:F
Credentials:DHSC, AT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2434
Mailing Address - Country:US
Mailing Address - Phone:419-448-2008
Mailing Address - Fax:419-448-2007
Practice Address - Street 1:310 E MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2434
Practice Address - Country:US
Practice Address - Phone:419-448-2008
Practice Address - Fax:419-448-2007
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT. 0036792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer