Most Relevant Information
Provider Data
| NPI Number: | 1003307364 |
| Provider Name: | JACQUELYN MARIE DERIAN BOEBEL OTR/L |
| Entity Type: | Individual |
| Taxonomy Code: | 225XP0200X |
| Specialty: | Occupational Therapist |
| License Number: | OT12947 |
Most Important Dates
| Enumeration Date: | 05/22/2018 |
| Last Updated: | 02/13/2021 |
Provider Practice Location
2331 20TH ST APT 3
SANTA MONICA
CA
904052737
Practice Location Phone/Fax
| Phone: | 8587223627 |
| Fax: |
Provider Mailing Location
2331 20TH ST APT 3
SANTA MONICA
CA
904052737
Provider Mailing Phone/Fax
| Phone: | 8587223627 |
| Fax: |