Provider Demographics
NPI:1235486887
Name:STEELY, JANESSA DIONNE (COTA/L)
Entity type:Individual
Prefix:
First Name:JANESSA
Middle Name:DIONNE
Last Name:STEELY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3918 PECAN GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:RUDY
Mailing Address - State:AR
Mailing Address - Zip Code:72952
Mailing Address - Country:US
Mailing Address - Phone:479-632-6337
Mailing Address - Fax:479-632-5916
Practice Address - Street 1:3918 PECAN GROVE RD
Practice Address - Street 2:
Practice Address - City:RUDY
Practice Address - State:AR
Practice Address - Zip Code:72952-9026
Practice Address - Country:US
Practice Address - Phone:479-632-6337
Practice Address - Fax:479-632-5916
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11951224Z00000X
MDA02695224Z00000X
AR699224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant