Provider Demographics
NPI:1346483609
Name:TATE, JOANN (JODY) EILEEN (MS,OTR/L)
Entity Type:Individual
Prefix:
First Name:JOANN (JODY)
Middle Name:EILEEN
Last Name:TATE
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12881 KNOTT ST STE 103
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3939
Mailing Address - Country:US
Mailing Address - Phone:714-892-6828
Mailing Address - Fax:714-898-9720
Practice Address - Street 1:12881 KNOTT ST STE 103
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-3939
Practice Address - Country:US
Practice Address - Phone:714-892-6828
Practice Address - Fax:714-898-9720
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05584225X00000X
CA10825225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist