Individual
JORDAN BOEDIARTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
141 S KNOTT AVE, ANAHEIM, CA 92804-1458
(714) 821-7310
Mailing address
9362 MAYRENE DR, GARDEN GROVE, CA 92841-4822
(714) 606-1945
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2553
CA
Other
Enumeration date
10/01/2020
Last updated
10/01/2020
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