Provider Demographics
NPI:1497125454
Name:ALVARADO, JENNIFER (OTR/L ID #: 15472)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:OTR/L ID #: 15472
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12610 RENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1924
Mailing Address - Country:US
Mailing Address - Phone:562-405-4661
Mailing Address - Fax:
Practice Address - Street 1:12610 RENVILLE ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-1924
Practice Address - Country:US
Practice Address - Phone:562-405-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-03
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15472225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health