Provider Demographics
NPI:1437628765
Name:MROZEK, JELINDA MARIE
Entity Type:Individual
Prefix:
First Name:JELINDA
Middle Name:MARIE
Last Name:MROZEK
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 1:7317 ENGLISH GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4375
Mailing Address - Country:US
Mailing Address - Phone:513-256-9982
Mailing Address - Fax:
Practice Address - Street 1:7317 ENGLISH GARDEN LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4375
Practice Address - Country:US
Practice Address - Phone:513-256-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-03011224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant