Provider Demographics
NPI:1295002509
Name:JOVENAL, CAROLINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:JOVENAL
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 1:2441 E PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-5101
Mailing Address - Country:US
Mailing Address - Phone:619-434-2063
Mailing Address - Fax:619-336-0201
Practice Address - Street 1:2441 E PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-5101
Practice Address - Country:US
Practice Address - Phone:619-434-2063
Practice Address - Fax:619-336-0201
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 9946225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist