Provider Demographics
NPI:1366125668
Name:LUSTENBERGER, JENNA (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LUSTENBERGER
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 1:8268 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:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT012535225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty