Provider Demographics
NPI:1649815333
Name:STUMPH, JANEEN (COTA)
Entity type:Individual
Prefix:MRS
First Name:JANEEN
Middle Name:
Last Name:STUMPH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10116 RAVENSWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-4536
Mailing Address - Country:US
Mailing Address - Phone:817-240-3506
Mailing Address - Fax:
Practice Address - Street 1:207 S OLD BETSY RD
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:TX
Practice Address - Zip Code:76059-2426
Practice Address - Country:US
Practice Address - Phone:817-645-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214226224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant