Provider Demographics
NPI:1356512339
Name:BOCKRATH, JANENE WITTIK (OTRL)
Entity type:Individual
Prefix:MRS
First Name:JANENE
Middle Name:WITTIK
Last Name:BOCKRATH
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:JANENE
Other - Middle Name:SUE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:715 FALCONER ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-1935
Mailing Address - Country:US
Mailing Address - Phone:716-665-4905
Mailing Address - Fax:716-665-8055
Practice Address - Street 1:715 FALCONER ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-1935
Practice Address - Country:US
Practice Address - Phone:716-665-4905
Practice Address - Fax:716-665-8055
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63014862225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist