Provider Demographics
NPI:1457489395
Name:JEWELL, JAN M (MA, OTR)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:M
Last Name:JEWELL
Suffix:
Gender:F
Credentials:MA, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 AVENIDA VISTA LABERA
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6516
Mailing Address - Country:US
Mailing Address - Phone:760-583-8616
Mailing Address - Fax:
Practice Address - Street 1:215 W CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-3622
Practice Address - Country:US
Practice Address - Phone:760-724-0831
Practice Address - Fax:760-631-0652
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA705225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics