Provider Demographics
NPI:1396230702
Name:RULFS, JANNAH NADINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JANNAH
Middle Name:NADINE
Last Name:RULFS
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 1:1260 HUNTINGTON DR STE 205
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4561
Mailing Address - Country:US
Mailing Address - Phone:424-324-9729
Mailing Address - Fax:
Practice Address - Street 1:1260 HUNTINGTON DR STE 205
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4561
Practice Address - Country:US
Practice Address - Phone:424-324-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT18742225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty