Individual
JACOB WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
860 GARVER RD, MIDDLETOWN, OH 45044-8923
(513) 300-4203
Mailing address
860 GARVER RD, MIDDLETOWN, OH 45044-8923
(513) 300-4203
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
OH
Other
Enumeration date
12/03/2025
Last updated
12/03/2025
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