Janelle Lynn Moffitt, D.T.
Individual provider Active NPI Developmental Therapist · Glenarm, IL
NPI 1013133081 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1013133081
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Developmental Therapist 222Q00000X
- License
- JM44781205P (IL)
- Practice address
- 10600 Old Indian Trail
Glenarm, IL 62536 - Phone
- (217) 483-6733
- NPI assigned
- Apr 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| JM44781205P | IL | MD | Developmental Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | JM44781205P | IL | Yes |
Addresses
Primary practice location
10600 Old Indian Trail
Glenarm, IL 62536
Mailing address
10600 Old Indian Trail
Glenarm, IL 62536
Phone (217) 483-6733
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.