Healthcare Provider Details

I. General information

NPI: 1306904388
Provider Name (Legal Business Name): JANISS DARLENE COBB RCP CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7249 HOLDERMAN ST
LEWIS CENTER OH
43035-8462
US

IV. Provider business mailing address

7249 HOLDERMAN ST
LEWIS CENTER OH
43035-8462
US

V. Phone/Fax

Practice location:
  • Phone: 740-549-6522
  • Fax:
Mailing address:
  • Phone: 740-549-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number5362
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: