Individual
MRS. JANE ELLEN HAZELTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
420 EASTLAWN DR, NORTH BALTIMORE, OH 45872-1309
(419) 420-5579
Mailing address
420 EASTLAWN DR, NORTH BALTIMORE, OH 45872-1309
(419) 420-5579
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
—
—
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0055748
—
OH
Enumeration date
06/22/2014
Last updated
06/22/2014
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