Individual
JACQUELINE MITTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
150 WELLS ST, WEST FARMINGTON, OH 44491-8748
(330) 889-9346
Mailing address
PO BOX 45, WEST FARMINGTON, OH 44491-0045
(330) 889-9346
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7802800
—
OH
Enumeration date
12/01/2020
Last updated
12/01/2020
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