Provider Demographics
NPI:1396016846
Name:DUVALL, JENNA D (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:D
Last Name:DUVALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:DOTSON
Other - Last Name:DUVALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:205 VERDUGO AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-3973
Mailing Address - Country:US
Mailing Address - Phone:626-327-6827
Mailing Address - Fax:626-963-0360
Practice Address - Street 1:205 VERDUGO AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3973
Practice Address - Country:US
Practice Address - Phone:626-327-6827
Practice Address - Fax:626-963-0360
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-14
Last Update Date:2015-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13165225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics