Provider Demographics
NPI:1811361140
Name:JAMISON, LILY MAI (OTA/L)
Entity Type:Individual
Prefix:MRS
First Name:LILY
Middle Name:MAI
Last Name:JAMISON
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1700 ADAMS AVE
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 AVE
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:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA835224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18968Medicare UPIN