Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119001293 | VA |
NPI | 1003070509 |
---|---|
Provider Name | Ms. Andrea Koren Englert |
First Address | Chesterfield, VA 23838-5275 |
Second Address | Chesterfield, VA 23838-5275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2008 |
Last Update Date | 30/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
053020656049 | (05) | VA |