Provider Demographics
NPI:1073650966
Name:DRAIN, JOANNE LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:LYNN
Last Name:DRAIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:LYNN
Other - Last Name:DOBROSIELSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:153 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-4839
Mailing Address - Country:US
Mailing Address - Phone:410-392-9400
Mailing Address - Fax:410-392-0577
Practice Address - Street 1:107 CHESAPEAKE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6313
Practice Address - Country:US
Practice Address - Phone:410-392-9400
Practice Address - Fax:410-392-0577
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1758225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant