Provider Demographics
NPI:1932845732
Name:POTIKOM, JANEJIT (OT)
Entity Type:Individual
Prefix:MS
First Name:JANEJIT
Middle Name:
Last Name:POTIKOM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 KIRKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-5033
Mailing Address - Country:US
Mailing Address - Phone:909-456-0495
Mailing Address - Fax:
Practice Address - Street 1:116 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3431
Practice Address - Country:US
Practice Address - Phone:686-357-9934
Practice Address - Fax:626-357-0164
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2740225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics