Provider Demographics
NPI:1831801190
Name:SEE, JACOB XAVIER (COTA)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:XAVIER
Last Name:SEE
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 SEMINARY RD APT 1132
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-2017
Mailing Address - Country:US
Mailing Address - Phone:703-731-3579
Mailing Address - Fax:
Practice Address - Street 1:38416 MORRISONVILLE RD
Practice Address - Street 2:
Practice Address - City:LOVETTSVILLE
Practice Address - State:VA
Practice Address - Zip Code:20180-3102
Practice Address - Country:US
Practice Address - Phone:703-298-5319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002771224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant