Provider Demographics
NPI:1730621368
Name:PERRY, JAMIE MARIE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MARIE
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:91 ORCHARD GRV
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-2525
Mailing Address - Country:US
Mailing Address - Phone:440-725-9905
Mailing Address - Fax:
Practice Address - Street 1:91 ORCHARD GRV
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-2525
Practice Address - Country:US
Practice Address - Phone:440-725-9905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0168105171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor