Provider Demographics
NPI:1609393933
Name:MCMILLAN, JEAN (OTR)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WELLESLEY DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4046
Mailing Address - Country:US
Mailing Address - Phone:757-223-5474
Mailing Address - Fax:
Practice Address - Street 1:50 WELLESLEY DR APT 416
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4050
Practice Address - Country:US
Practice Address - Phone:757-223-5474
Practice Address - Fax:757-223-5474
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001326225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist