Provider Demographics
NPI:1962839597
Name:JANN, JOANNA (MSOT/L)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:
Last Name:JANN
Suffix:
Gender:F
Credentials:MSOT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 TIMBERLEA LN
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1721
Mailing Address - Country:US
Mailing Address - Phone:315-635-6839
Mailing Address - Fax:
Practice Address - Street 1:3141 TIMBERLEA LN.
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027
Practice Address - Country:US
Practice Address - Phone:315-635-6839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP89464251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)