Provider Demographics
NPI:1730220583
Name:GREENWELL, JANA M (OT)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:M
Last Name:GREENWELL
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 1:2811 LONGVIEW DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5919
Mailing Address - Country:US
Mailing Address - Phone:870-974-9114
Mailing Address - Fax:870-974-9184
Practice Address - Street 1:2811 LONGVIEW DR
Practice Address - Street 2:SUITE C
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5919
Practice Address - Country:US
Practice Address - Phone:870-974-9114
Practice Address - Fax:870-974-9184
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR978225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129139721Medicaid
AR5W191OtherBLUE CROSS BLUE SHIELD