Jacquelyn Marie Derian Boebel, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OT12947 Issued in CA

Practice address

2331 20TH St Apt 3
Santa Monica, CA 90405-2737

Phone

(858) 722-3627

NPI assigned

May 22, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613174400000",
    "number": "1003307364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2331 20TH ST APT 3",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904052737",
            "telephone_number": "858-722-3627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2331 20TH ST APT 3",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904052737",
            "telephone_number": "858-722-3627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERIAN BOEBEL",
        "first_name": "JACQUELYN",
        "middle_name": "MARIE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-22",
        "last_updated": "2021-02-13",
        "certification_date": "2021-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "CA",
            "license": "OT12947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Swati Desai, PHD., LCSW

• Pediatric Occupational Therapist in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Pediatric Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.