Provider Demographics
NPI:1598434003
Name:HIGH, JENNIFER AZARES (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AZARES
Last Name:HIGH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JENNIFER LOURDES
Other - Middle Name:FERALES
Other - Last Name:AZARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1422 REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-3136
Mailing Address - Country:US
Mailing Address - Phone:760-408-5575
Mailing Address - Fax:
Practice Address - Street 1:105 TERRACINA BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4845
Practice Address - Country:US
Practice Address - Phone:909-793-2271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2799225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology