Provider Demographics
NPI:1538694351
Name:JANSSEN, KAYLI MICHELLE
Entity Type:Individual
Prefix:
First Name:KAYLI
Middle Name:MICHELLE
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLI
Other - Middle Name:MICHELLE
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2061 WRIGHT AVE
Mailing Address - Street 2:UNIT A7
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-5837
Mailing Address - Country:US
Mailing Address - Phone:909-519-8912
Mailing Address - Fax:
Practice Address - Street 1:2061 WRIGHT AVE
Practice Address - Street 2:UNIT A7
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-5837
Practice Address - Country:US
Practice Address - Phone:909-519-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2974224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant