Provider Demographics
NPI:1114973088
Name:WHITAKER, JENNIFER LYNN (OTRL, CAPS)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:OTRL, CAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14318 DENBY TER
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4320
Mailing Address - Country:US
Mailing Address - Phone:804-334-8050
Mailing Address - Fax:804-379-8664
Practice Address - Street 1:14318 DENBY TER
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4320
Practice Address - Country:US
Practice Address - Phone:804-334-8050
Practice Address - Fax:804-379-8664
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001262225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist