Provider Demographics
NPI:1699984237
Name:REIFMAN, JACLYNN SHIBUYA (OTR)
Entity type:Individual
Prefix:MRS
First Name:JACLYNN
Middle Name:SHIBUYA
Last Name:REIFMAN
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 1:2609 STARKEY WAY
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-1424
Mailing Address - Country:US
Mailing Address - Phone:619-445-9049
Mailing Address - Fax:
Practice Address - Street 1:9000 WAKARUSA ST
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3307
Practice Address - Country:US
Practice Address - Phone:619-740-4600
Practice Address - Fax:619-589-7638
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA771225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand