Healthcare Provider Details

I. General information

NPI: 1679798391
Provider Name (Legal Business Name): JAY ALAN FORD OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 E PROSPERITY AVE
TULARE CA
93274-8051
US

IV. Provider business mailing address

701 W CENTER AVE
VISALIA CA
93291-6015
US

V. Phone/Fax

Practice location:
  • Phone: 559-631-4588
  • Fax: 559-271-6970
Mailing address:
  • Phone: 559-713-6806
  • Fax: 559-713-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4938
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT18659
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number4938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: