Provider Demographics
NPI:1043556848
Name:MANSOURIAN, JENNIFER V (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:V
Last Name:MANSOURIAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:S
Other - Last Name:VO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:14335 PINNEY ST
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-5038
Mailing Address - Country:US
Mailing Address - Phone:949-285-8368
Mailing Address - Fax:
Practice Address - Street 1:14335 PINNEY ST
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-5038
Practice Address - Country:US
Practice Address - Phone:949-285-8368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-25
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT12802225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist