Provider Demographics
NPI:1720199847
Name:ROLLS, JANELLE J (OTRL)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:J
Last Name:ROLLS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:J
Other - Last Name:WAKELIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:407 BLACK HILLS AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-3243
Mailing Address - Country:US
Mailing Address - Phone:308-762-6564
Mailing Address - Fax:308-762-3747
Practice Address - Street 1:407 BLACK HILLS AVENUE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-3243
Practice Address - Country:US
Practice Address - Phone:308-762-6564
Practice Address - Fax:308-762-3747
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE415224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant