Provider Demographics
NPI:1801913652
Name:MOLLER, NATHANIEL (COTA)
Entity type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:
Last Name:MOLLER
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10005 FOX CHASE DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-7759
Mailing Address - Country:US
Mailing Address - Phone:513-583-1285
Mailing Address - Fax:
Practice Address - Street 1:10005 FOX CHASE DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-7759
Practice Address - Country:US
Practice Address - Phone:513-583-1285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00855224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant