Provider Demographics
NPI:1578895819
Name:JAYNE, BENJAMIN (MS, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:JAYNE
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24950 VIA FLORECER APT 82
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-2461
Mailing Address - Country:US
Mailing Address - Phone:949-273-8271
Mailing Address - Fax:
Practice Address - Street 1:1220 HEMLOCK WAY STE 202
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3656
Practice Address - Country:US
Practice Address - Phone:714-656-2371
Practice Address - Fax:949-608-1549
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10605225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics