Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 06487 | MD |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 06487 | MD |
NPI | 1609193051 |
---|---|
Provider Name | Jennie Samuel |
First Address | Fort Belvoir, VA 22060 |
Second Address | Fort Belvoir, VA 22060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2010 |
Last Update Date | 01/05/2015 |