Provider Demographics
NPI:1578823795
Name:JIMMONS, JULIA L (COTA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:L
Last Name:JIMMONS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15037 LOFTHILL DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5141
Mailing Address - Country:US
Mailing Address - Phone:714-690-9825
Mailing Address - Fax:
Practice Address - Street 1:15037 LOFTHILL DR
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-5141
Practice Address - Country:US
Practice Address - Phone:714-690-9825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA736224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification