=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922602176
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANELL YONKMAN MS,OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2020
-----------------------------------------------------
Last Update Date | 11/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 W 7TH ST STE 104
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47404-3835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-562-0703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 W 7TH ST STE 104
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47404-3835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-562-0703
-----------------------------------------------------
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 | 31003476A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------