Healthcare Provider Details

I. General information

NPI: 1811220221
Provider Name (Legal Business Name): AMY JANSUK MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 VALENCIA ST APT 201
SAN FRANCISCO CA
94103-6503
US

IV. Provider business mailing address

18512 HAWTHORNE BLVD
TORRANCE CA
90504-4515
US

V. Phone/Fax

Practice location:
  • Phone: 415-987-1939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number10838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: