Provider Demographics
NPI:1396492583
Name:BANOM, JANESSE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JANESSE
Middle Name:
Last Name:BANOM
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 1:165 APPLEGARTH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5905
Mailing Address - Country:US
Mailing Address - Phone:407-749-3151
Mailing Address - Fax:
Practice Address - Street 1:2350 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:ALLENWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08720-7037
Practice Address - Country:US
Practice Address - Phone:732-683-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty