Basic Information
| Provider Information | |||||||||
| NPI: | 1306365903 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SIK | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 S WOOSTER ST APT 101 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900351715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153353895 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4081 E OLYMPIC BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900233330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232670477 | ||||||||
| FaxNumber: | 4153353895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2017 | ||||||||
| LastUpdateDate: | 09/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 117886 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.