Provider Demographics
NPI:1083763510
Name:MONSELLE, JENNIFER CHRISTY (OTRL)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CHRISTY
Last Name:MONSELLE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:KAREN
Other - Last Name:GASKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTRL
Mailing Address - Street 1:37431 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-6651
Mailing Address - Country:US
Mailing Address - Phone:510-797-0481
Mailing Address - Fax:
Practice Address - Street 1:1440 168TH AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2409
Practice Address - Country:US
Practice Address - Phone:510-481-6421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5250225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist