Provider Demographics
NPI:1477729333
Name:WILLOUGHBY, JANET CAROL (MS OTRL)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:CAROL
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:CAROL
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTRL
Mailing Address - Street 1:840 PURDY LODGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-6043
Mailing Address - Country:US
Mailing Address - Phone:727-492-5935
Mailing Address - Fax:
Practice Address - Street 1:3030 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6792
Practice Address - Country:US
Practice Address - Phone:702-360-1137
Practice Address - Fax:702-341-1511
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11-0084225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics