Provider Demographics
NPI:1235610189
Name:BAUDENDISTEL-TURNER, JODY
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:BAUDENDISTEL-TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-1635
Mailing Address - Country:US
Mailing Address - Phone:513-785-4846
Mailing Address - Fax:
Practice Address - Street 1:1371 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1635
Practice Address - Country:US
Practice Address - Phone:513-785-4846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH.0003875225X00000X
OH.0003874225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist