Healthcare Provider Details

I. General information

NPI: 1720199847
Provider Name (Legal Business Name): JANELLE J ROLLS OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANELLE J WAKELIN OTRL

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 BLACK HILLS AVENUE
ALLIANCE NE
69301-3243
US

IV. Provider business mailing address

407 BLACK HILLS AVENUE
ALLIANCE NE
69301-3243
US

V. Phone/Fax

Practice location:
  • Phone: 308-762-6564
  • Fax: 308-762-3747
Mailing address:
  • Phone: 308-762-6564
  • Fax: 308-762-3747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number415
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: