Healthcare Provider Details

I. General information

NPI: 1457489395
Provider Name (Legal Business Name): JAN M. JEWELL M.A., OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W CALIFORNIA AVE
VISTA CA
92083-3622
US

IV. Provider business mailing address

1785 AVENIDA VISTA LABERA
OCEANSIDE CA
92056-6516
US

V. Phone/Fax

Practice location:
  • Phone: 760-724-0831
  • Fax: 760-631-0652
Mailing address:
  • Phone: 760-583-8616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: