Provider Demographics
NPI:1972822815
Name:OBERMEYER, JO ELLEN (OTR)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ELLEN
Last Name:OBERMEYER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3247 BITTERSWEET DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9515
Mailing Address - Country:US
Mailing Address - Phone:812-481-2633
Mailing Address - Fax:812-634-7907
Practice Address - Street 1:3247 BITTERSWEET DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9515
Practice Address - Country:US
Practice Address - Phone:812-481-2633
Practice Address - Fax:812-634-7907
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001188A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist