MEDICARE: MRS. JENNIFER JO WELCH OTR

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	814	CA

General Provider Information

NPI Number	:	1366612582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER JO WELCH OTR

Provider Business Mailing Address
First Line	:	1419 STANFORD ST
Second Line	:	APT. D
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-3145
Country	:	US
Telephone Number	:	469-585-6702
Fax Number	:

Provider Business Practice Location Address
First Line	:	1419 STANFORD ST
Second Line	:	APT. D
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-3145
Country	:	US
Telephone Number	:	469-585-6702
Fax Number	:

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

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	03/04/2008

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