Healthcare Provider Details

I. General information

NPI: 1174417430
Provider Name (Legal Business Name): JENNIFER TOBIN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 JORDAN AVE
SAN FRANCISCO CA
94118-2565
US

IV. Provider business mailing address

127 JORDAN AVE
SAN FRANCISCO CA
94118-2565
US

V. Phone/Fax

Practice location:
  • Phone: 415-533-7469
  • Fax:
Mailing address:
  • Phone: 415-533-7469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5638
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number5345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: