Provider Demographics
NPI:1598301350
Name:JARZOMB, KELLI (OTR/L)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:JARZOMB
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:PANTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5332 E HANBURY ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5332 E HANBURY ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1918
Practice Address - Country:US
Practice Address - Phone:562-900-6591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty