Healthcare Provider Details

I. General information

NPI: 1053615088
Provider Name (Legal Business Name): JILL BOSMAN BOSTIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILL BOSMAN

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8097 HAMILTON AVE
CINCINNATI OH
45231-2321
US

IV. Provider business mailing address

6548 WOODSTONE CT
LIBERTY TWP OH
45044-9668
US

V. Phone/Fax

Practice location:
  • Phone: 513-931-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number00787
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: