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General NPI Number Information
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NPI Number | 1366125668
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Entity Type | Individual
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Provider Name | JENNA LUSTENBERGER OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 10800 CAMPBELL RD
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City | HARRISON
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State | OH
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Zip | 45030-8969
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Country | US
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Telephone | 513-367-4139
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Fax |
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Provider Business Mailing Address
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Address Line | 8268 FAWN KNOLL CT
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City | CINCINNATI
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State | OH
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Zip | 45247-4506
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Country | US
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Telephone | 513-212-3795
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT012535
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License Number State | OH
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