Provider Demographics
NPI:1407082431
Name:FRAZIER, JEANETTE WALKER (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:WALKER
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-8406
Mailing Address - Country:US
Mailing Address - Phone:276-666-7590
Mailing Address - Fax:276-666-7593
Practice Address - Street 1:1313 HIDDEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-8406
Practice Address - Country:US
Practice Address - Phone:276-666-7590
Practice Address - Fax:276-666-7593
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003863225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist