Provider Demographics
NPI:1932331881
Name:HEARD, JONELL FLYTHE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JONELL
Middle Name:FLYTHE
Last Name:HEARD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 OAKLAND CHASE PKWY
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-5745
Mailing Address - Country:US
Mailing Address - Phone:804-562-5475
Mailing Address - Fax:
Practice Address - Street 1:1553 OAKLAND CHASE PKWY
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-5745
Practice Address - Country:US
Practice Address - Phone:804-562-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004806225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist