Provider Demographics
NPI:1770930695
Name:JANKE, KATHRYN DIANE (OTR/L)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DIANE
Last Name:JANKE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:D
Other - Last Name:JANKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:228 TABOR VIEW LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4576
Mailing Address - Country:US
Mailing Address - Phone:336-768-9978
Mailing Address - Fax:
Practice Address - Street 1:440 INGRAM DR
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-8208
Practice Address - Country:US
Practice Address - Phone:336-983-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0498225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist