Provider Demographics
NPI:1902125412
Name:REIDER, JENNIFER MARGARET (LMT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARGARET
Last Name:REIDER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MARGARET
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:8060 DARTMOOR RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7609
Mailing Address - Country:US
Mailing Address - Phone:440-231-3824
Mailing Address - Fax:
Practice Address - Street 1:9853 JOHNNYCAKE RIDGE RD
Practice Address - Street 2:STE 306A
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6700
Practice Address - Country:US
Practice Address - Phone:440-231-3824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH018631174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist