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General NPI Number Information
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NPI Number | 1215348651
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Entity Type | Individual
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Provider Name | JASON OCKEY COTA/L
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Gender | Male
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 661 W 1ST ST
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City | TUSTIN
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State | CA
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Zip | 92780-2939
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Country | US
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Telephone | 714-838-2853
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Fax |
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Provider Business Mailing Address
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Address Line | 1932 SIERRA VISTA DR
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City | TUSTIN
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State | CA
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Zip | 92780-5239
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Country | US
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Telephone | 714-470-6567
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 2492
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License Number State | CA
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