Provider Demographics
NPI:1598814485
Name:SPRAGUE, JANINE MARIE I (OTR)
Entity Type:Individual
Prefix:MS
First Name:JANINE
Middle Name:MARIE
Last Name:SPRAGUE
Suffix:I
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:JANINE
Other - Middle Name:MARIE
Other - Last Name:SPRAGUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:8076 ARROWWOOD CT
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-9174
Mailing Address - Country:US
Mailing Address - Phone:812-299-3405
Mailing Address - Fax:812-299-3405
Practice Address - Street 1:8076 ARROWWOOD CT
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-9174
Practice Address - Country:US
Practice Address - Phone:812-299-3405
Practice Address - Fax:812-299-3405
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001418A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist