Provider Demographics
NPI:1609081579
Name:DRAKE, JANELLE DEROY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:DEROY
Last Name:DRAKE
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 1:393 CABRILL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-9019
Mailing Address - Country:US
Mailing Address - Phone:843-571-3479
Mailing Address - Fax:
Practice Address - Street 1:393 CABRILL DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-9019
Practice Address - Country:US
Practice Address - Phone:843-571-3479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3053225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics