Provider Demographics
NPI:1447609078
Name:TILL, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TILL
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:PO BOX 643398
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-3398
Mailing Address - Country:US
Mailing Address - Phone:513-221-1100
Mailing Address - Fax:513-569-5297
Practice Address - Street 1:544 CENTRE VIEW BLVD.
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3400
Practice Address - Country:US
Practice Address - Phone:513-221-1100
Practice Address - Fax:513-569-5225
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-04
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.014175225100000X
KYPT.007042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist