Individual
JENNY LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
5620 MASON DR, SAN BERNARDINO, CA 92407-0246
(909) 887-9523
Mailing address
5620 MASON DR, SAN BERNARDINO, CA 92407-0246
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
12580
CA
Other
Enumeration date
02/25/2013
Last updated
02/25/2013
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