Provider Demographics
NPI:1740726462
Name:SURDAK, JEANNE (OTR/L, MSCHA)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:SURDAK
Suffix:
Gender:F
Credentials:OTR/L, MSCHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 SHADOWBROOK COURT
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374
Mailing Address - Country:US
Mailing Address - Phone:714-371-8492
Mailing Address - Fax:
Practice Address - Street 1:567 SHADOWBROOK CT
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-6474
Practice Address - Country:US
Practice Address - Phone:714-371-8492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1347225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist