Provider Demographics
NPI:1831382571
Name:PHILLIPS, JANENE PATRICIA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JANENE
Middle Name:PATRICIA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:JANENE
Other - Middle Name:PATRICIA
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:10 STURBRIDGE LANE
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554
Mailing Address - Country:US
Mailing Address - Phone:540-659-3810
Mailing Address - Fax:540-659-3810
Practice Address - Street 1:2604 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-5011
Practice Address - Country:US
Practice Address - Phone:540-657-1423
Practice Address - Fax:540-657-1424
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004330225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics