Individual
JENNIFER LYNNE DISTEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18 MINERVA ST, TIFFIN, OH 44883-1556
(567) 230-3858
Mailing address
18 MINERVA ST, TIFFIN, OH 44883-1556
(567) 230-3858
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
OH
3747P1801X
Personal Care Attendant
—
—
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
04/03/2023
Last updated
04/13/2023
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