Provider Demographics
NPI:1881176980
Name:LITZEL, JILL AMY
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:AMY
Last Name:LITZEL
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 1:4698 FOREST BROOK DR
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-1155
Mailing Address - Country:US
Mailing Address - Phone:330-524-6460
Mailing Address - Fax:
Practice Address - Street 1:838 COBURN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1459
Practice Address - Country:US
Practice Address - Phone:330-315-3729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist