Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119001129 | VA |
N | 225XG0600X | Occupational Therapist - Gerontology | ||
N | 225XP0200X | Occupational Therapist - Pediatrics | 0119001129 | VA |
NPI | 1144467622 |
---|---|
Provider Name | Mrs. Jennifer M Mccormick |
First Address | Stone Ridge, VA 20105-2988 |
Second Address | Stone Ridge, VA 20105-2988 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2009 |
Last Update Date | 10/07/2014 |