Provider Demographics
NPI:1750807269
Name:GIACONIA, JANINE M (MOT)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:M
Last Name:GIACONIA
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:M
Other - Last Name:PALINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT
Mailing Address - Street 1:1034 WINTER PARK DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-5689
Mailing Address - Country:US
Mailing Address - Phone:631-626-0499
Mailing Address - Fax:
Practice Address - Street 1:1034 WINTER PARK DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-5689
Practice Address - Country:US
Practice Address - Phone:631-626-0499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program