Provider Demographics
NPI:1861250961
Name:NORTH, JENNICA (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:JENNICA
Middle Name:
Last Name:NORTH
Suffix:
Gender:F
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 1:1601 EASTMAN AVE UNIT 103
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6441
Mailing Address - Country:US
Mailing Address - Phone:805-650-6290
Mailing Address - Fax:
Practice Address - Street 1:1601 EASTMAN AVE UNIT 103
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6441
Practice Address - Country:US
Practice Address - Phone:805-650-6290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT26029225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics