Provider Demographics
NPI:1346568680
Name:MATHIAS, JESSICA ERIN (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ERIN
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17609 VENTURA BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5126
Mailing Address - Country:US
Mailing Address - Phone:818-530-7971
Mailing Address - Fax:818-501-8325
Practice Address - Street 1:17609 VENTURA BLVD STE 215
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5126
Practice Address - Country:US
Practice Address - Phone:818-530-7971
Practice Address - Fax:818-501-8325
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10889225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist