Provider Demographics
NPI:1679744858
Name:DRISKO, JANELLE (OT)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:DRISKO
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 1:4402 QUAIL CREEK TRCE S
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46167-8963
Mailing Address - Country:US
Mailing Address - Phone:317-371-6684
Mailing Address - Fax:317-718-0097
Practice Address - Street 1:3380 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-9089
Practice Address - Country:US
Practice Address - Phone:317-718-0089
Practice Address - Fax:317-718-0087
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004704225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist