Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
N | 213E00000X | Podiatrist | LPO306 | OH |
N | 222Z00000X | Podiatrist | LPO306 | OH |
Y | 224P00000X | Prosthetist | LPO306 | OH |
N | 225000000X | Orthotic Fitter |
NPI | 1407093859 |
---|---|
Provider Name | Mr. Jeremy Farley |
First Address | Hilliard, OH 43085 |
Second Address | Hilliard, OH 43085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2009 |
Last Update Date | 01/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CP 3518 | AMERICAN BOARD OF CERTIFICATION IN PROSTHETIC AND ORTHOTICS (01) |