Provider Demographics
NPI:1366612582
Name:WELCH, JENNIFER JO (OTR)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JO
Last Name:WELCH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 STANFORD ST
Mailing Address - Street 2:APT. D
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3145
Mailing Address - Country:US
Mailing Address - Phone:469-585-6702
Mailing Address - Fax:
Practice Address - Street 1:1419 STANFORD ST
Practice Address - Street 2:APT. D
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3145
Practice Address - Country:US
Practice Address - Phone:469-585-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA814225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist