Provider Demographics
NPI:1801257118
Name:DIGRADO, JENNIE LINN (OTR, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:LINN
Last Name:DIGRADO
Suffix:
Gender:F
Credentials:OTR, OTR/L
Other - Prefix:MRS
Other - First Name:JENNIE
Other - Middle Name:LINN
Other - Last Name:DIGRADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:4605 BRIAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-2233
Mailing Address - Country:US
Mailing Address - Phone:719-250-0938
Mailing Address - Fax:
Practice Address - Street 1:700 WINDY POINT DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-1701
Practice Address - Country:US
Practice Address - Phone:760-591-3012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12990225X00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist