1497753412 NPI number — MRS. JEANNETTE MARIE MULLER OT

Table of content: DR. MARY CAROLINE MENDOZA-NEWMAN PH.D. (NPI 1912026246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497753412 NPI number — MRS. JEANNETTE MARIE MULLER OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLER
Provider First Name:
JEANNETTE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497753412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 S LOOP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDGEWOOD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017-3405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-301-2663
Provider Business Mailing Address Fax Number:
859-817-7848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6620 CLOUGH PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45244-4053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-221-2663
Provider Business Practice Location Address Fax Number:
859-817-7848
Provider Enumeration Date:
07/13/2005

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:  OT003799 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9342332 . This is a "PHCS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000328341 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2507102 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00781789 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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