Healthcare Provider Details

I. General information

NPI: 1881096618
Provider Name (Legal Business Name): JENNIFER CANARIS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 WINDWARD WAY
CHULA VISTA CA
91914-4526
US

IV. Provider business mailing address

2405 STEAMBOAT SPRINGS CT
CHULA VISTA CA
91915-2223
US

V. Phone/Fax

Practice location:
  • Phone: 619-948-9449
  • Fax:
Mailing address:
  • Phone: 619-421-1013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License NumberOT 3698
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License NumberOT 3698
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 3698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: