Individual
JACKIE E. WOLGAMOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
111 FORREST AVE, LEESBURG, OH 45135-9620
(330) 260-0311
Mailing address
111 FORREST AVE, LEESBURG, OH 45135-9620
(330) 260-0311
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
0105027
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0105027
—
OH
Enumeration date
10/13/2020
Last updated
10/13/2020
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