Provider Demographics
NPI:1003489675
Name:YAP, JODIE (OTR)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:YAP
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N LAKE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-5120
Mailing Address - Country:US
Mailing Address - Phone:626-568-9115
Mailing Address - Fax:
Practice Address - Street 1:831 E HUNTINGTON DR STE 203
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-6424
Practice Address - Country:US
Practice Address - Phone:626-358-9671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
CA22705225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist