Provider Demographics
NPI:1265441554
Name:VONDERHAAR, JEROME ROBERT (OTR/L)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:ROBERT
Last Name:VONDERHAAR
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 1:1617 HILLTREE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-3200
Mailing Address - Country:US
Mailing Address - Phone:513-474-8442
Mailing Address - Fax:
Practice Address - Street 1:103 LANDMARK DR
Practice Address - Street 2:SIUTE 380
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073-1393
Practice Address - Country:US
Practice Address - Phone:859-392-3970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1561174400000X
KYR2471174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist