Provider Demographics
NPI:1073068433
Name:KENT, JILLIAN CLAIR (C/OTA)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:CLAIR
Last Name:KENT
Suffix:
Gender:F
Credentials:C/OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 DAMON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45218-1040
Mailing Address - Country:US
Mailing Address - Phone:513-256-0589
Mailing Address - Fax:
Practice Address - Street 1:6281 TRI RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-8345
Practice Address - Country:US
Practice Address - Phone:866-791-5766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA.06489224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant