Healthcare Provider Details

I. General information

NPI: 1003284563
Provider Name (Legal Business Name): JESSICA A DORAN MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8840 N MAGNOLIA AVE STE 220
SANTEE CA
92071-4516
US

IV. Provider business mailing address

19401 S VERMONT AVE STE A200
TORRANCE CA
90502-4418
US

V. Phone/Fax

Practice location:
  • Phone: 619-749-7059
  • Fax:
Mailing address:
  • Phone: 310-323-6887
  • Fax: 310-436-8285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number16246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: