Active NPI
Jane Mardelette Lim Obenieta, OTR
- Occupational Therapist
- San Rafael, CA
National Provider Identifier
1073147120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 17644
- Practice address
- 4000 Civic Center Dr Ste 300
San Rafael, CA 94903-4129 - Phone
- (628) 877-0040
- NPI assigned
- Feb 27, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 17644 | CA | Primary |
Addresses
Primary practice location
4000 Civic Center Dr Ste 300
San Rafael, CA 94903-4129
Mailing address
2840 Channel Reef Ave
Tulare, CA 93274-7509
Phone (559) 361-1816
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17644 | CA | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582761600000",
"number": "1073147120",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2840 CHANNEL REEF AVE",
"city": "TULARE",
"state": "CA",
"postal_code": "932747509",
"telephone_number": "559-361-1816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 CIVIC CENTER DR STE 300",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949034129",
"telephone_number": "628-877-0040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OBENIETA",
"first_name": "JANE MARDELETTE",
"middle_name": "LIM",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-27",
"last_updated": "2020-02-27",
"certification_date": "2020-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "17644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.