Provider Demographics
NPI:1174911309
Name:JEYAPAUL, ISAC (OTR/L)
Entity type:Individual
Prefix:
First Name:ISAC
Middle Name:
Last Name:JEYAPAUL
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13104 GLEN CT UNIT 70
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1126
Mailing Address - Country:US
Mailing Address - Phone:909-933-3780
Mailing Address - Fax:909-933-3780
Practice Address - Street 1:13104 GLEN CT UNIT 70
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1126
Practice Address - Country:US
Practice Address - Phone:909-933-3780
Practice Address - Fax:909-933-3780
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 949225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist