Provider Demographics
NPI:1689325755
Name:BLACKSHER, JENNIFER (OTR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BLACKSHER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:884 KENT DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3311
Mailing Address - Country:US
Mailing Address - Phone:909-973-9849
Mailing Address - Fax:
Practice Address - Street 1:884 KENT DR
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3311
Practice Address - Country:US
Practice Address - Phone:909-973-9849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist