Provider Demographics
NPI:1174950349
Name:WIRTH, JAIME A (CO)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:A
Last Name:WIRTH
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
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Mailing Address - Street 1:3700 BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-3603
Mailing Address - Country:US
Mailing Address - Phone:423-697-0057
Mailing Address - Fax:423-648-9366
Practice Address - Street 1:3700 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-3603
Practice Address - Country:US
Practice Address - Phone:423-697-0057
Practice Address - Fax:423-648-9366
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist