Provider Demographics
NPI:1245899848
Name:LORD-TOVAR, JAMIE (COTA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:LORD-TOVAR
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:CHRISTINE
Other - Last Name:LORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 N SIERRA BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2110
Mailing Address - Country:US
Mailing Address - Phone:310-425-9816
Mailing Address - Fax:
Practice Address - Street 1:1000 S FREMONT AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8834
Practice Address - Country:US
Practice Address - Phone:626-289-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4784224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant