Provider Demographics
NPI:1306270319
Name:MITCHELL, JEFFREY DAVID (OT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-2820
Mailing Address - Country:US
Mailing Address - Phone:805-686-9352
Mailing Address - Fax:
Practice Address - Street 1:621 W MICHELTORENA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-4195
Practice Address - Country:US
Practice Address - Phone:805-253-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3122225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist