1316503881 NPI number — JOAN M. NIENABER OTR/L

Table of content: JOAN M. NIENABER OTR/L (NPI 1316503881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316503881 NPI number — JOAN M. NIENABER OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIENABER
Provider First Name:
JOAN
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PFEIFER
Provider Other First Name:
JOAN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316503881
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVELAND
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80537-0305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-593-8769
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 CHERRY HILL RD STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARSIPPANY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07054-1102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-909-5159
Provider Business Practice Location Address Fax Number:
973-909-5112
Provider Enumeration Date:
05/10/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT.0002363 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)