MEDICARE: ISAC JEYAPAUL OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT 949	CA

General Provider Information

NPI Number	:	1174911309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAC JEYAPAUL OTR/L

Provider Business Mailing Address
First Line	:	13104 GLEN CT UNIT 70
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-1126
Country	:	US
Telephone Number	:	909-933-3780
Fax Number	:	909-933-3780

Provider Business Practice Location Address
First Line	:	13104 GLEN CT UNIT 70
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-1126
Country	:	US
Telephone Number	:	909-933-3780
Fax Number	:	909-933-3780

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2014
Last Update Date	:	12/22/2014

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