Provider Demographics
NPI:1588211817
Name:SEYMOUR, JANE ADELE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ADELE
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 HURRICANE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:VANSANT
Mailing Address - State:VA
Mailing Address - Zip Code:24656-7668
Mailing Address - Country:US
Mailing Address - Phone:276-312-3808
Mailing Address - Fax:
Practice Address - Street 1:2226 HURRICANE CREEK RD
Practice Address - Street 2:
Practice Address - City:VANSANT
Practice Address - State:VA
Practice Address - Zip Code:24656-7668
Practice Address - Country:US
Practice Address - Phone:276-312-3808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000603224Z00000X
TN3272224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant