Provider Demographics
NPI:1568587798
Name:DYMOND, JANINE H
Entity Type:Individual
Prefix:MS
First Name:JANINE
Middle Name:H
Last Name:DYMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR4 BOX 646
Mailing Address - Street 2:
Mailing Address - City:W PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18643
Mailing Address - Country:US
Mailing Address - Phone:570-388-4094
Mailing Address - Fax:
Practice Address - Street 1:RR4 BOX 646
Practice Address - Street 2:ENCORE THERAPY SERVICES INC
Practice Address - City:W PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18643
Practice Address - Country:US
Practice Address - Phone:570-388-4094
Practice Address - Fax:570-388-2104
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0C003201L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018888770002Medicaid