Provider Demographics
NPI:1922128297
Name:JEWETT, CYNTHIA JEANNE (MA OTR L)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JEANNE
Last Name:JEWETT
Suffix:
Gender:F
Credentials:MA OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 NW CATAWBA RD
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-2817
Mailing Address - Country:US
Mailing Address - Phone:419-797-9503
Mailing Address - Fax:
Practice Address - Street 1:700 HELEN ST
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-2051
Practice Address - Country:US
Practice Address - Phone:419-547-9595
Practice Address - Fax:419-547-1605
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 002528225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist