Provider Demographics
NPI:1962099416
Name:WRIGHT, JEREMY
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:WRIGHT
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 1:46562 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACOBSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43933-9783
Mailing Address - Country:US
Mailing Address - Phone:614-940-6125
Mailing Address - Fax:
Practice Address - Street 1:46562 MAIN ST
Practice Address - Street 2:
Practice Address - City:JACOBSBURG
Practice Address - State:OH
Practice Address - Zip Code:43933-9783
Practice Address - Country:US
Practice Address - Phone:614-940-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0702061OtherDEPARTMENT OF DEVELOPMENTAL DISABILITIES