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NPI Code Detail

MEDICARE: PAMELA J JANUS OT

MEDICARE: PAMELA J JANUS OT
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
1225X00000XOccupational Therapist4207-026WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14207-026OTHERWILICENSE

General Provider Information

NPI Number : 1982631230
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA J JANUS OT
Provider Business Mailing Address
First Line : PO BOX 22487
Second Line :
City : GREEN BAY
State : WI
Zip : 54305-2487
Country : US
Telephone Number : 920-445-7210
Fax Number : 920-445-7289
Provider Business Practice Location Address
First Line : 744 S WEBSTER AVE
Second Line :
City : GREEN BAY
State : WI
Zip : 54301-3581
Country : US
Telephone Number : 920-433-7864
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 11/23/2022

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