Provider Demographics
NPI:1043474380
Name:TEPSICK, JONATHAN GEORGE (AT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:GEORGE
Last Name:TEPSICK
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 CREEK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8398
Mailing Address - Country:US
Mailing Address - Phone:513-733-9333
Mailing Address - Fax:513-588-2479
Practice Address - Street 1:4701 CREEK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-8398
Practice Address - Country:US
Practice Address - Phone:513-554-8080
Practice Address - Fax:513-554-8082
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0030322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0225920002Medicare NSC