Healthcare Provider Details

I. General information

NPI: 1962529156
Provider Name (Legal Business Name): JANELLE JOY SMESTAD OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 W SAINT GEORGE AVE
GRANTSBURG WI
54840-7827
US

IV. Provider business mailing address

23098 SMESTAD RD
GRANTSBURG WI
54840-9002
US

V. Phone/Fax

Practice location:
  • Phone: 715-463-5353
  • Fax: 715-463-2423
Mailing address:
  • Phone: 715-463-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2817-026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: