Provider Demographics
NPI:1346726890
Name:JAHANGIRPURWALA, HINAKAUSAR (COTA)
Entity Type:Individual
Prefix:
First Name:HINAKAUSAR
Middle Name:
Last Name:JAHANGIRPURWALA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12075 TANGO LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-6101
Mailing Address - Country:US
Mailing Address - Phone:703-300-7735
Mailing Address - Fax:
Practice Address - Street 1:14906 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4016
Practice Address - Country:US
Practice Address - Phone:703-491-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001948224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant