MEDICARE: JANNAH NADINE RULFS 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	OT18742	CA

General Provider Information

NPI Number	:	1396230702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANNAH NADINE RULFS OTR/L

Provider Business Mailing Address
First Line	:	1260 HUNTINGTON DR STE 205
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4561
Country	:	US
Telephone Number	:	424-324-9729
Fax Number	:

Provider Business Practice Location Address
First Line	:	1260 HUNTINGTON DR STE 205
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4561
Country	:	US
Telephone Number	:	424-324-9729
Fax Number	:

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

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	08/28/2020

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