MEDICARE: JADE BANIK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	007854	OH

General Provider Information

NPI Number	:	1447184809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADE BANIK

Provider Business Mailing Address
First Line	:	8125 GILLS HOLLOW RD
Second Line	:
City	:	ROSEVILLE
State	:	OH
Zip	:	43777-9762
Country	:	US
Telephone Number	:	740-891-8027
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 STATE ROUTE 664 N
Second Line	:
City	:	LOGAN
State	:	OH
Zip	:	43138-8541
Country	:	US
Telephone Number	:	740-380-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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Directions to “ JADE BANIK ” Practice Location

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