MEDICARE: MISS CYNTHIA VANDEILEN OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT008509	OH

General Provider Information

NPI Number	:	1992255731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CYNTHIA VANDEILEN OTR/L

Provider Business Mailing Address
First Line	:	4110 CAMBRIDGE TRL
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45430-2308
Country	:	US
Telephone Number	:	937-312-5898
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 W PETE ROSE WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45203-1892
Country	:	US
Telephone Number	:	513-381-3380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2016
Last Update Date	:	10/05/2016

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