Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0119003700 | VA |
N | 225XH1200X | Occupational Therapist - Hand | 0119003700 | VA |
NPI | 1205850260 |
---|---|
Provider Name | Stephanie C Jones |
First Address | Virginia Beach, VA 23462-1832 |
Second Address | Virginia Beach, VA 23456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 23/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C05501 | MEDICARE GROUP (01) | VA |