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General NPI Number Information
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NPI Number | 1275046245
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Entity Type | Individual
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Provider Name | JACOB RYAN DAMANTE MS OTR/L
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Gender | Male
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 4964 TELEGRAPH RD
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City | VENTURA
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State | CA
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Zip | 93003-8181
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Country | US
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Telephone | 805-856-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 622 LANTANA ST APT 53
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City | CAMARILLO
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State | CA
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Zip | 93010-6113
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Country | US
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Telephone | 530-219-5898
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 6915
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License Number State | AZ
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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 | 22430
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License Number State | CA
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