Healthcare Provider Details

I. General information

NPI: 1801313812
Provider Name (Legal Business Name): JENNIFER NOEL KOBAYASHI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 S WESTERN AVE APT 114
ANAHEIM CA
92804-4750
US

IV. Provider business mailing address

1230 S WESTERN AVE APT 114
ANAHEIM CA
92804-4750
US

V. Phone/Fax

Practice location:
  • Phone: 714-827-2137
  • Fax:
Mailing address:
  • Phone: 714-827-2137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: