Provider Demographics
NPI:1801800735
Name:JANEK, JOAN S (OT)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:S
Last Name:JANEK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-0671
Mailing Address - Country:US
Mailing Address - Phone:401-253-5314
Mailing Address - Fax:401-253-5314
Practice Address - Street 1:450 HOPE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-1834
Practice Address - Country:US
Practice Address - Phone:401-253-5314
Practice Address - Fax:401-253-5314
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT 00343225X00000X
RI3051225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI21383-7OtherBLUE CROSS/BLUE SHEILD
RI407436OtherBLUE CHIP