Provider Demographics
NPI:1255005971
Name:MECKSTROTH, RALPH WALTER IV (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:WALTER
Last Name:MECKSTROTH
Suffix:IV
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2599 RITTENHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OH
Mailing Address - Zip Code:45052-9719
Mailing Address - Country:US
Mailing Address - Phone:513-262-7659
Mailing Address - Fax:
Practice Address - Street 1:2599 RITTENHOUSE RD
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OH
Practice Address - Zip Code:45052-9719
Practice Address - Country:US
Practice Address - Phone:513-262-7659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-2794225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist