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General NPI Number Information
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NPI Number | 1578895819
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Entity Type | Individual
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Provider Name | BENJAMIN JAYNE MS, OTR/L
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Gender | Male
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Dates
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Enumeration Date | 02/11/2010
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Last Update Date | 02/11/2010
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Provider Practice Location Address
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Address Line | 1220 HEMLOCK WAY STE 202
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City | SANTA ANA
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State | CA
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Zip | 92707-3656
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Country | US
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Telephone | 714-656-2371
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Fax | 949-608-1549
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Provider Business Mailing Address
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Address Line | 24950 VIA FLORECER APT 82
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City | MISSION VIEJO
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State | CA
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Zip | 92692-2461
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Country | US
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Telephone | 949-273-8271
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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 | 10605
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License Number State | CA
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