Healthcare Provider Details

I. General information

NPI: 1053661926
Provider Name (Legal Business Name): STEPHANIE JAE BUEHLER O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 LITTLE YORK RD SUITE 10
DAYTON OH
45414-5800
US

IV. Provider business mailing address

PO BOX 713130
CINCINNATI OH
45271-0001
US

V. Phone/Fax

Practice location:
  • Phone: 937-415-9100
  • Fax: 937-415-9191
Mailing address:
  • Phone: 937-415-9100
  • Fax: 937-415-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number008138
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: