Provider Demographics
NPI:1053858464
Name:OLLINGER, JONATHAN M
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:OLLINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S OHIO AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-3112
Mailing Address - Country:US
Mailing Address - Phone:937-726-4983
Mailing Address - Fax:
Practice Address - Street 1:402 S OHIO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-3112
Practice Address - Country:US
Practice Address - Phone:937-726-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.013078225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist