Provider Demographics
NPI:1124230867
Name:PRANTL, SANDRA (OTRL, CST-D)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:PRANTL
Suffix:
Gender:F
Credentials:OTRL, CST-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5137 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2237
Mailing Address - Country:US
Mailing Address - Phone:513-351-0775
Mailing Address - Fax:513-351-2515
Practice Address - Street 1:5137 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2237
Practice Address - Country:US
Practice Address - Phone:513-351-0775
Practice Address - Fax:513-351-2515
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-00925225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist