Healthcare Provider Details

I. General information

NPI: 1740939461
Provider Name (Legal Business Name): JENNIFER ANNE LONDON MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 03/21/2022
Certification Date: 03/07/2022
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

2053 TETON PASS ST
EL CAJON CA
92019-4210
US

V. Phone/Fax

Practice location:
  • Phone: 619-749-7059
  • Fax: 619-749-7069
Mailing address:
  • Phone: 916-990-3560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number23431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: