Provider Demographics
NPI:1356083091
Name:O'TOOLE, JENNIFER ANN (PTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:O'TOOLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 VALIANT ST
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1909
Mailing Address - Country:US
Mailing Address - Phone:707-287-3933
Mailing Address - Fax:
Practice Address - Street 1:2217 SUNSET BLVD STE 711
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4783
Practice Address - Country:US
Practice Address - Phone:916-435-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48838225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant