Provider Demographics
NPI:1528738218
Name:JANA ROTHBAUER OTR LLC
Entity type:Organization
Organization Name:JANA ROTHBAUER OTR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:ROTHBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:469-659-6757
Mailing Address - Street 1:527 CHRISTOPHER CT
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-8242
Mailing Address - Country:US
Mailing Address - Phone:469-659-6757
Mailing Address - Fax:
Practice Address - Street 1:527 CHRISTOPHER CT
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-8242
Practice Address - Country:US
Practice Address - Phone:469-659-6757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty