Provider Demographics
NPI:1700137742
Name:KLINK, JANICE R (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:R
Last Name:KLINK
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 N.W. 9TH AVE
Mailing Address - Street 2:MERCER COUNTY HOSPTIAL
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231-1258
Mailing Address - Country:US
Mailing Address - Phone:309-582-5301
Mailing Address - Fax:309-582-3737
Practice Address - Street 1:409 N.W 9TH AVE
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231-1258
Practice Address - Country:US
Practice Address - Phone:309-582-5301
Practice Address - Fax:309-582-3737
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.002028225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL366007544001Medicaid
IL366007544001Medicaid
IL142304Medicare PIN
IL141304Medicare Oscar/Certification
IL141304Medicare PIN