Provider Demographics
NPI:1134900202
Name:TRIESLER, JEREMY (JD(C), MALS, BSCJ)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:TRIESLER
Suffix:
Gender:M
Credentials:JD(C), MALS, BSCJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9318 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-9322
Mailing Address - Country:US
Mailing Address - Phone:330-466-9885
Mailing Address - Fax:
Practice Address - Street 1:9318 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-9322
Practice Address - Country:US
Practice Address - Phone:330-466-9885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH94057667344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi