Provider Demographics
NPI:1902879273
Name:FORD, JEREMY LEE (ATC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:LEE
Last Name:FORD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 PORTAGE LAKES DR
Mailing Address - Street 2:APT A
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-2392
Mailing Address - Country:US
Mailing Address - Phone:330-644-4575
Mailing Address - Fax:
Practice Address - Street 1:444 N MAIN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3110
Practice Address - Country:US
Practice Address - Phone:330-379-9488
Practice Address - Fax:330-379-5511
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00-19202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer