Provider Demographics
NPI:1205362761
Name:UPHOLZ, JONATHAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:UPHOLZ
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16750 VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44023-9206
Mailing Address - Country:US
Mailing Address - Phone:440-465-0707
Mailing Address - Fax:
Practice Address - Street 1:16750 VICTORIA DR
Practice Address - Street 2:
Practice Address - City:AUBURN TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44023-9206
Practice Address - Country:US
Practice Address - Phone:440-465-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT009789225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist