MEDICARE: DANIEL JOLLES OTR/L, OTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	20418	CA

General Provider Information

NPI Number	:	1831740273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JOLLES OTR/L, OTD

Provider Business Mailing Address
First Line	:	3030 REGENT ST APT 2
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 REGENT ST APT 2
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2526
Country	:	US
Telephone Number	:	559-907-5900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2019
Last Update Date	:	09/26/2019

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