Provider Demographics
NPI:1003067364
Name:SCHMIDT, JILL STEGALL (OT/L)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:STEGALL
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 DEVONSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-7212
Mailing Address - Country:US
Mailing Address - Phone:602-616-1863
Mailing Address - Fax:
Practice Address - Street 1:21750 RED RUM DR STE 117
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5867
Practice Address - Country:US
Practice Address - Phone:703-574-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005006225XP0200X
MD08968225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1841933595Medicaid