Provider Demographics
NPI:1699190447
Name:SWEENEY, JANELLE MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:MARIE
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 RUGER LN
Mailing Address - Street 2:
Mailing Address - City:SWOOPE
Mailing Address - State:VA
Mailing Address - Zip Code:24479-2337
Mailing Address - Country:US
Mailing Address - Phone:540-414-3339
Mailing Address - Fax:
Practice Address - Street 1:1410 N AUGUSTA ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2401
Practice Address - Country:US
Practice Address - Phone:540-886-6233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000349224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant