Individual
JORDAN KENNETH VANDERYT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
201 MARGE SCHOTT WAY, MAINEVILLE, OH 45039-8863
(513) 583-5161
Mailing address
888 FRANKLIN RD APT 3, WAYNESVILLE, OH 45068-8130
(513) 208-1460
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA008534
OH
Other
Enumeration date
11/03/2023
Last updated
11/03/2023
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