Provider Demographics
NPI:1730577925
Name:WOLSHIRE, JAYSON (MED, AT)
Entity type:Individual
Prefix:MR
First Name:JAYSON
Middle Name:
Last Name:WOLSHIRE
Suffix:
Gender:M
Credentials:MED, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10225 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-8511
Mailing Address - Country:US
Mailing Address - Phone:937-572-9910
Mailing Address - Fax:
Practice Address - Street 1:1166 DUBLIN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1030
Practice Address - Country:US
Practice Address - Phone:937-572-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT11652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer