Provider Demographics
NPI:1598881971
Name:ANCELL, JANET C (OTR)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:C
Last Name:ANCELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34333 KESTREL AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-4935
Mailing Address - Country:US
Mailing Address - Phone:660-385-1904
Mailing Address - Fax:
Practice Address - Street 1:1706 PROSPECT DR
Practice Address - Street 2:SUITE B
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2615
Practice Address - Country:US
Practice Address - Phone:660-385-6540
Practice Address - Fax:660-385-6542
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004405225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist