Provider Demographics
NPI:1427739762
Name:JENNA LUSTENBERGER
Entity type:Organization
Organization Name:JENNA LUSTENBERGER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSTENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-212-3795
Mailing Address - Street 1:8268 FAWN KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-4506
Mailing Address - Country:US
Mailing Address - Phone:513-212-3795
Mailing Address - Fax:
Practice Address - Street 1:10800 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-8969
Practice Address - Country:US
Practice Address - Phone:513-367-4139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty