Healthcare Provider Details

I. General information

NPI: 1396187506
Provider Name (Legal Business Name): JAIMEE CRISWELL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAIMEE HARRIS OTR/L

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 CONVOY ST SUITE 204
SAN DIEGO CA
92111-3742
US

IV. Provider business mailing address

1821 DONALOR DR
ESCONDIDO CA
92027-4424
US

V. Phone/Fax

Practice location:
  • Phone: 858-514-0375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT 10886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: