Provider Demographics
NPI:1659266542
Name:MERCADO, JENNIFER BAUTISTA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BAUTISTA
Last Name:MERCADO
Suffix:
Gender:X
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 1:6939 ALABAMA AVE UNIT 210
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2074
Mailing Address - Country:US
Mailing Address - Phone:818-633-4703
Mailing Address - Fax:
Practice Address - Street 1:6939 ALABAMA AVE UNIT 210
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2074
Practice Address - Country:US
Practice Address - Phone:818-633-4703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16748225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist