=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033934443
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANELL MARIE NISKANEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2024
-----------------------------------------------------
Last Update Date | 11/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 MAPLE RIDGE RD
-----------------------------------------------------
City | NEGAUNEE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-458-1080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 MAPLE RIDGE RD
-----------------------------------------------------
City | NEGAUNEE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-458-1080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 5201001183
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------