Dietl, Jordan

Dietl, Jordan is an individual health care provider with primary practice located at 13610 Barrett Office Dr Ste 104 , Ballwin MO 63021-7818. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, which is considered as her primary health care specialty. Dietl, Jordan can be contacted via phone (314) 822-5107.

Contact Information

Primary practice address
13610 Barrett Office Dr Ste 104 Ballwin MO 63021-7818
Phone: (314) 822-5107
Fax: (314) 822-5106
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist 225X00000X 2015033703 Missouri

Profile Details

NPI number 1538522693
LBN Legal business name Dietl, Jordan
Credentials Occupational Therapist (OT)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 5th, 2016
Last updated Apr 5th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538522693 NPPES
Missouri Other 2015033703 OT LICENSE #

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