Provider Demographics
NPI:1114099389
Name:JEWELL, MARY COLETTE (OT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:COLETTE
Last Name:JEWELL
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 1:2515 E PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-5678
Mailing Address - Country:US
Mailing Address - Phone:559-280-5661
Mailing Address - Fax:559-625-0389
Practice Address - Street 1:1827 S COURT ST
Practice Address - Street 2:SUITE C
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-5469
Practice Address - Country:US
Practice Address - Phone:559-627-3274
Practice Address - Fax:559-627-3284
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 1600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist