Provider Demographics
NPI:1992018519
Name:JANSSEN, BETHANY G (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:G
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 COLLEGE AVE
Mailing Address - Street 2:APT. WW
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4723
Mailing Address - Country:US
Mailing Address - Phone:424-832-0245
Mailing Address - Fax:
Practice Address - Street 1:5757 COLLEGE AVE
Practice Address - Street 2:APT. WW
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4723
Practice Address - Country:US
Practice Address - Phone:800-787-6787
Practice Address - Fax:866-401-4170
Is Sole Proprietor?:No
Enumeration Date:2010-07-24
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8311225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA225X00000XOtherOCCUPATIONAL THERAPIST