Provider Demographics
NPI:1770112369
Name:GEER, JESSICA (PTA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GEER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:OH
Mailing Address - Zip Code:43540-9785
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 W MAIN ST
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:OH
Practice Address - Zip Code:43540-9785
Practice Address - Country:US
Practice Address - Phone:419-250-0927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0133741146N00000X
OH5035208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0133741OtherOHIO DEPARTMENT OF PUBLIC SAFETY
OHPTA-5035OtherSTATE OF OHIO PT/OT/AT BOARD