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General NPI Number Information
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NPI Number | 1245167055
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Entity Type | Individual
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Provider Name | MRS. JEANIE MARIE PHELPS
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Gender | Female
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Dates
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Enumeration Date | 05/06/2026
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Last Update Date | 05/06/2026
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Provider Practice Location Address
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Address Line | 379 N VIRAGE ST
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City | ORANGE
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State | CA
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Zip | 92869-2856
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Country | US
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Telephone | 714-997-6271
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 N HANDY ST
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City | ORANGE
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State | CA
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Zip | 92867-4434
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Country | US
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Telephone | 714-628-4000
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 18039
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 18039
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License Number State | CA
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