Provider Demographics
NPI:1427665405
Name:LONNEMAN, MARIAH FAITH (OTR/L)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:FAITH
Last Name:LONNEMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11276 CAROLINA TRACE RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:OH
Mailing Address - Zip Code:45030-9312
Mailing Address - Country:US
Mailing Address - Phone:513-313-2617
Mailing Address - Fax:
Practice Address - Street 1:400 N ERIE HWY STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4264
Practice Address - Country:US
Practice Address - Phone:513-877-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT011014225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist