Provider Demographics
NPI:1265728034
Name:NOWAK, JEANNETTE B (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:B
Last Name:NOWAK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 ORCHARD PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4098
Mailing Address - Country:US
Mailing Address - Phone:716-677-3620
Mailing Address - Fax:716-674-7821
Practice Address - Street 1:1397 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4098
Practice Address - Country:US
Practice Address - Phone:716-677-3620
Practice Address - Fax:716-674-7821
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000614-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist