Provider Demographics
NPI:1982980330
Name:EDMUNDS, JENNIFER (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:EDMUNDS
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 1:2761 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8329
Mailing Address - Country:US
Mailing Address - Phone:540-657-1423
Mailing Address - Fax:540-657-1424
Practice Address - Street 1:2761 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 209
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8329
Practice Address - Country:US
Practice Address - Phone:540-657-1423
Practice Address - Fax:540-657-1424
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005479225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist