Provider Demographics
NPI:1558651109
Name:FURNISS, JEREMY RYAN (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:RYAN
Last Name:FURNISS
Suffix:
Gender:M
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 1:4101 8TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-7909
Mailing Address - Country:US
Mailing Address - Phone:202-656-2118
Mailing Address - Fax:
Practice Address - Street 1:4101 8TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7909
Practice Address - Country:US
Practice Address - Phone:202-656-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT0100006766225XG0600X
VA0119005205225XG0600X
AROTR2083225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology