MEDICARE: DARYL FITZGERALD

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	101Y00000X	Counselor
2	225600000X	Dance Therapist
3	225C00000X	Rehabilitation Counselor
4	373H00000X	Day Training/Habilitation Specialist
5	374U00000X	Home Health Aide
6	376G00000X	Nursing Home Administrator
7	376J00000X	Homemaker
8	376K00000X	Nurse's Aide
9	172A00000X	Driver	T67507941	VA

General Provider Information

NPI Number	:	1497114375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL FITZGERALD

Provider Business Mailing Address
First Line	:	927 JENKINS CHURCH RD
Second Line	:
City	:	CUMBERLAND
State	:	VA
Zip	:	23040-2036
Country	:	US
Telephone Number	:	804-491-6655
Fax Number	:

Provider Business Practice Location Address
First Line	:	927 JENKINS CHURCH RD
Second Line	:
City	:	CUMBERLAND
State	:	VA
Zip	:	23040-2036
Country	:	US
Telephone Number	:	434-906-5922
Fax Number	:

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

Provider Enumeration Date	:	02/19/2016
Last Update Date	:	09/02/2020

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