Provider Demographics
NPI:1811312887
Name:POEPPELMAN, JUDITH (COTA/L AND RN)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:POEPPELMAN
Suffix:
Gender:F
Credentials:COTA/L AND RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 DEARBAUGH AVE
Mailing Address - Street 2:STE2
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-9245
Mailing Address - Country:US
Mailing Address - Phone:419-738-3422
Mailing Address - Fax:
Practice Address - Street 1:1045 DEARBAUGH AVE STE 2
Practice Address - Street 2:SUITE 2
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-9245
Practice Address - Country:US
Practice Address - Phone:419-738-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRN 138964163W00000X
OHOTA 02749224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No163W00000XNursing Service ProvidersRegistered Nurse