Provider Demographics
NPI:1497753412
Name:MULLER, JEANNETTE MARIE (OT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:MARIE
Last Name:MULLER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S LOOP RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3405
Mailing Address - Country:US
Mailing Address - Phone:859-301-2663
Mailing Address - Fax:859-817-7848
Practice Address - Street 1:6620 CLOUGH PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-4053
Practice Address - Country:US
Practice Address - Phone:513-221-2663
Practice Address - Fax:859-817-7848
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT003799225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9342332OtherPHCS
OH000000328341OtherANTHEM
OH2507102Medicaid
OHP00781789OtherMEDICARE RAILROAD
Q21470Medicare UPIN
OH0225920002Medicare NSC
OHH194950Medicare PIN