Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 32002800A | IN |
NPI | 1013510668 |
---|---|
Provider Name | Angela Marie Janis |
First Address | Nabb, IN 47147-7067 |
Second Address | Scottsburg, IN 47170-7755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2020 |
Last Update Date | 17/11/2020 |