Provider Demographics
NPI:1609897438
Name:OTT, JENNIFER STARMANN (MPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:STARMANN
Last Name:OTT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CHRISTINE
Other - Last Name:STARMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:11240 WAPLES MILL RD
Mailing Address - Street 2:STE 403
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-395-4707
Mailing Address - Fax:703-691-4933
Practice Address - Street 1:3620 JOSEPH SIEWICK DR
Practice Address - Street 2:STE 100A
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1756
Practice Address - Country:US
Practice Address - Phone:703-810-5227
Practice Address - Fax:703-810-5224
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA014154C95Medicare ID - Type Unspecified