Provider Demographics
NPI:1154075935
Name:RASTEGAR, JENNIFER MAUNDONNA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MAUNDONNA
Last Name:RASTEGAR
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:657 DONNA MAE CT
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-1611
Mailing Address - Country:US
Mailing Address - Phone:151-067-2647
Mailing Address - Fax:
Practice Address - Street 1:657 DONNA MAE CT
Practice Address - Street 2:
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803-1611
Practice Address - Country:US
Practice Address - Phone:510-672-6477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12664225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist