Provider Demographics
NPI: | 1255862769 |
---|---|
Name: | MILLINER, JENNIE C (OTR/L) |
Entity Type: | Individual |
Prefix: | |
First Name: | JENNIE |
Middle Name: | C |
Last Name: | MILLINER |
Suffix: | |
Gender: | F |
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: | 36624 GALLERY LN |
Mailing Address - Street 2: | |
Mailing Address - City: | BEAUMONT |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92223-8130 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 909-522-7925 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 36624 GALLERY LN |
Practice Address - Street 2: | |
Practice Address - City: | BEAUMONT |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92223-8130 |
Practice Address - Country: | US |
Practice Address - Phone: | 909-522-7925 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2017-03-26 |
Last Update Date: | 2018-10-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 13948 | 225XE0001X, 225XG0600X, 225XH1300X, 225XL0004X, 225XN1300X, 225XP0019X, 225XR0403X, 225X00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | |
No | 225XE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification |
No | 225XG0600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology |
No | 225XH1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Human Factors |
No | 225XL0004X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Low Vision |
No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation |
No | 225XR0403X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Driving and Community Mobility |