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General NPI Number Information
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NPI Number | 1902125412
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Entity Type | Individual
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Provider Name | JENNIFER MARGARET REIDER L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2010
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 9853 JOHNNYCAKE RIDGE RD STE 306A
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City | MENTOR
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State | OH
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Zip | 44060-6700
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Country | US
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Telephone | 440-231-3824
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Fax |
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Provider Business Mailing Address
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Address Line | 8060 DARTMOOR RD
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City | MENTOR
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State | OH
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Zip | 44060-7609
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Country | US
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Telephone | 440-231-3824
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 018631
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License Number State | OH
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