Healthcare Provider Details

I. General information

NPI: 1619017498
Provider Name (Legal Business Name): JANISS D COBB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 12/22/2011
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: 740-548-0914
Mailing address:
  • Phone: 740-549-6522
  • Fax: 740-548-0914

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: MRS. JANISS DARLENE COBB
Title or Position: RESPIRATORY THERAPIST
Credential: RCP CRT
Phone: 740-549-6522