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NPI Code Detail

MEDICARE: JASON GILMORE

MEDICARE: JASON GILMORE
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
1224Z00000XOccupational Therapy Assistant1352CA

General Provider Information

NPI Number : 1851590277
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON GILMORE
Provider Business Mailing Address
First Line : 7246 FOREST HILL AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23225-1524
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7246 FOREST HILL AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23225-1524
Country : US
Telephone Number : 804-320-7901
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2007
Last Update Date : 07/16/2007

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