Active NPI
Jemma Jasmin Bolaoen, OTR/L
- Occupational Therapist
- Encino, CA
National Provider Identifier
1760168645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT25008
- Practice address
- 16500 Ventura Blvd Suite 414
Encino, CA 91436 - Phone
- (818) 788-1003
- NPI assigned
- Jun 26, 2023
- 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 | OT25008 | CA | Primary |
Addresses
Primary practice location
16500 Ventura Blvd Suite 414
Encino, CA 91436
Mailing address
16500 Ventura Blvd Suite 414
Encino, CA 91436
Phone (818) 788-1003
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 |
|---|---|---|---|
| OT25008 | CA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Speech and Language Pathology Associates Inc. | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Speech-Language Pathologist
- Encino, CA
- NPI 1124271614
Occupational Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687737600000",
"number": "1760168645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16500 VENTURA BLVD SUITE 414",
"city": "ENCINO",
"state": "CA",
"postal_code": "91436",
"telephone_number": "818-788-1003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16500 VENTURA BLVD SUITE 414",
"city": "ENCINO",
"state": "CA",
"postal_code": "91436",
"telephone_number": "818-788-1003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLAOEN",
"first_name": "JEMMA",
"middle_name": "JASMIN",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-26",
"last_updated": "2023-06-26",
"certification_date": "2023-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "OT25008",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Encino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.