Provider Demographics
NPI:1215353990
Name:SIVERD, JEANNE
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:
Last Name:SIVERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DEBARTOLO PLACE
Mailing Address - Street 2:SUITE #220
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-965-7828
Mailing Address - Fax:330-965-7901
Practice Address - Street 1:11300 COLUMBIANA-CANFIELD RD.
Practice Address - Street 2:SUITE E
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406
Practice Address - Country:US
Practice Address - Phone:330-549-3430
Practice Address - Fax:330-549-3430
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-02247224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant