Provider Demographics
NPI:1508115171
Name:PHILLIPS, JANNIE SUE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JANNIE
Middle Name:SUE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JANNIE
Other - Middle Name:SUE
Other - Last Name:NEHLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2917 14TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613
Mailing Address - Country:US
Mailing Address - Phone:828-291-3523
Mailing Address - Fax:
Practice Address - Street 1:2917 14TH AVE NE
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613
Practice Address - Country:US
Practice Address - Phone:828-291-3523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3125225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology