Provider Demographics
NPI:1134249022
Name:GROOM, JANNA NOELLE (MOTR)
Entity type:Individual
Prefix:MRS
First Name:JANNA
Middle Name:NOELLE
Last Name:GROOM
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 OXFORD OAK DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8483
Mailing Address - Country:US
Mailing Address - Phone:614-868-8788
Mailing Address - Fax:
Practice Address - Street 1:1425 YORKLAND RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-1686
Practice Address - Country:US
Practice Address - Phone:614-751-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06117225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist