Provider Demographics
NPI:1386472561
Name:THOMAS, JASYN SR
Entity type:Individual
Prefix:
First Name:JASYN
Middle Name:
Last Name:THOMAS
Suffix:SR
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 1:165 HOLLINGER AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1221
Mailing Address - Country:US
Mailing Address - Phone:330-472-6078
Mailing Address - Fax:
Practice Address - Street 1:165 HOLLINGER AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1221
Practice Address - Country:US
Practice Address - Phone:330-472-6078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver