Provider Demographics
NPI:1629201231
Name:MACATANGAY, JENNIFER CLOSA (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CLOSA
Last Name:MACATANGAY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:TOLENTINO
Other - Last Name:CLOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2055 26TH ST S APT 404
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2892
Mailing Address - Country:US
Mailing Address - Phone:703-953-6380
Mailing Address - Fax:
Practice Address - Street 1:2055 26TH ST S APT 404
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2892
Practice Address - Country:US
Practice Address - Phone:703-953-6380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-30
Last Update Date:2009-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI0119004058225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist