Provider Demographics
NPI:1568662799
Name:BERRY, JENNIFER E (MS, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:E
Last Name:BERRY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2869 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4512
Mailing Address - Country:US
Mailing Address - Phone:703-299-0051
Mailing Address - Fax:703-299-0052
Practice Address - Street 1:218 N LEE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2660
Practice Address - Country:US
Practice Address - Phone:703-299-0051
Practice Address - Fax:703-299-0052
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003232225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist