Provider Demographics
NPI:1588983068
Name:SERRANO, JEREMIE (OTR/L)
Entity type:Individual
Prefix:
First Name:JEREMIE
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 ROYALTY DR
Mailing Address - Street 2:270
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3030
Mailing Address - Country:US
Mailing Address - Phone:909-623-2020
Mailing Address - Fax:909-623-2424
Practice Address - Street 1:1902 ROYALTY DR
Practice Address - Street 2:270
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3030
Practice Address - Country:US
Practice Address - Phone:909-623-2020
Practice Address - Fax:909-623-2424
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10316225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist