MEDICARE: MRS. JANICE LEE DALBY OTR

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	174400000X	Specialist	OT 4450	CA

General Provider Information

NPI Number	:	1912002122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANICE LEE DALBY OTR

Provider Business Mailing Address
First Line	:	15808 CUMBERLAND DR
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-2345
Country	:	US
Telephone Number	:	858-679-6996
Fax Number	:	858-673-5434

Provider Business Practice Location Address
First Line	:	11665 AVENA PL
Second Line	:	SUITE 106
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2421
Country	:	US
Telephone Number	:	858-673-5437
Fax Number	:	858-673-5434

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/21/2022

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