Provider Demographics
NPI:1104238609
Name:CRIVELLO, JENNIFER (OTR/L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CRIVELLO
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 1:380 VISTA ROMA WAY
Mailing Address - Street 2:UNIT 204
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-4415
Mailing Address - Country:US
Mailing Address - Phone:408-425-1922
Mailing Address - Fax:
Practice Address - Street 1:380 VISTA ROMA WAY
Practice Address - Street 2:UNIT 204
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-4415
Practice Address - Country:US
Practice Address - Phone:408-425-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 8018225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist