MEDICARE: MRS. JENNIFER LYNN PIMENTEL OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	310320

General Provider Information

NPI Number	:	1417396755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LYNN PIMENTEL OTR

Provider Business Mailing Address
First Line	:	414 LONDON ST
Second Line	:	APT 3
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-2546
Country	:	US
Telephone Number	:	505-205-2990
Fax Number	:

Provider Business Practice Location Address
First Line	:	7700 ARLINGTON BLVD
Second Line	:	STE 5113
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-2929
Country	:	US
Telephone Number	:	703-681-9025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	06/20/2013

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