Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0119000243 | VA |
NPI | 1063634111 |
---|---|
Provider Name | Mrs. Jennifer Ann Cryan |
First Address | Virginia Beach, VA 23454-6004 |
Second Address | Virginia Beach, VA 23454-5803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |