Healthcare Provider Details

I. General information

NPI: 1992973069
Provider Name (Legal Business Name): JANET LOUISE OTTERSBERG OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANET LOUISE OTTERSBERG-SMITH OTR/L

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MADISON AVE UNIT 322
PASADENA CA
91101-4540
US

IV. Provider business mailing address

30 N. MADISON AVE. #322
PASADENA CA
91101
US

V. Phone/Fax

Practice location:
  • Phone: 719-406-8777
  • Fax:
Mailing address:
  • Phone: 719-406-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: