Provider Demographics
NPI:1568728095
Name:LOUGHMILLER, JEANELLA SUE
Entity Type:Individual
Prefix:MRS
First Name:JEANELLA
Middle Name:SUE
Last Name:LOUGHMILLER
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 1:394 E COUNTY ROAD 1300 N
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-6853
Mailing Address - Country:US
Mailing Address - Phone:812-236-9700
Mailing Address - Fax:
Practice Address - Street 1:501 S MURPHY AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-8316
Practice Address - Country:US
Practice Address - Phone:812-446-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000111A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant