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General NPI Number Information
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NPI Number | 1013510668
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Entity Type | Individual
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Provider Name | ANGELA MARIE JANIS
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Gender | Female
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 1350 N TODD DR
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City | SCOTTSBURG
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State | IN
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Zip | 47170-7755
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Country | US
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Telephone | 812-752-5663
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Fax |
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Provider Business Mailing Address
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Address Line | 7657 E TANK POND RD
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City | NABB
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State | IN
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Zip | 47147-7067
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Country | US
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Telephone | 181-257-2303
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 32002800A
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License Number State | IN
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