Provider Demographics
NPI:1770677486
Name:ROYAL, JANET (OTR)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:ROYAL
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 1:1700 ADAMS AVENUE
Mailing Address - Street 2:STE 103
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-556-2288
Mailing Address - Fax:714-435-1745
Practice Address - Street 1:1700 ADAMS AVENUE
Practice Address - Street 2:STE 103
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:714-556-2288
Practice Address - Fax:714-435-1745
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT57225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA002OtherTRICARE
CAOT0000570OtherBLUE SHIELD
CAA002OtherTRICARE