Provider Demographics
NPI:1003792987
Name:OKEL, JEANNINE CARLEN (COTA)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:CARLEN
Last Name:OKEL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:JEANNINE
Other - Middle Name:CARLEN
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:1020 TIERRA DEL REY # A-1
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7886
Mailing Address - Country:US
Mailing Address - Phone:619-585-7104
Mailing Address - Fax:
Practice Address - Street 1:1020 TIERRA DEL REY # A1
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7886
Practice Address - Country:US
Practice Address - Phone:619-585-7104
Practice Address - Fax:619-585-7104
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty