Provider Demographics
NPI:1346490844
Name:CROTINGER, JANELL RENEE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:RENEE
Last Name:CROTINGER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 SW WANAMAKER RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5269
Mailing Address - Country:US
Mailing Address - Phone:785-271-6808
Mailing Address - Fax:785-271-1189
Practice Address - Street 1:2515 SW WANAMAKER RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5269
Practice Address - Country:US
Practice Address - Phone:785-271-6808
Practice Address - Fax:785-271-1189
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00514314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS175172Medicare UPIN