Provider Demographics
NPI:1376816553
Name:ASCHE, JANAE (MS OT)
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:
Last Name:ASCHE
Suffix:
Gender:F
Credentials:MS OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ELBERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30635-2401
Mailing Address - Country:US
Mailing Address - Phone:423-423-4897
Mailing Address - Fax:
Practice Address - Street 1:255 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-2401
Practice Address - Country:US
Practice Address - Phone:423-423-4897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004720225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOT004720OtherSTATE LICENSE