Basic Information
| Provider Information | |||||||||
| NPI: | 1992018519 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANSSEN | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5757 COLLEGE AVE | ||||||||
| Address2: | APT. WW | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921204723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4248320245 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5757 COLLEGE AVE | ||||||||
| Address2: | APT. WW | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921204723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007876787 | ||||||||
| FaxNumber: | 8664014170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2010 | ||||||||
| LastUpdateDate: | 07/24/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 8311 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 225X00000X | 01 | CA | OCCUPATIONAL THERAPIST | OTHER |