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General NPI Number Information
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NPI Number | 1740445055
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Entity Type | Individual
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Provider Name | JANELLE CARISSA KLOSKE MOTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/25/2008
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 486 CENTURY LN STE 204
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City | HOLLAND
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State | MI
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Zip | 49423-4295
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Country | US
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Telephone | 360-440-4531
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Fax |
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Provider Business Mailing Address
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Address Line | 336 WILDWOOD DR
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City | HOLLAND
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State | MI
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Zip | 49423-6921
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Country | US
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Telephone | 360-440-4531
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT00004506
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 13583
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5201007200
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License Number State | MI
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