Healthcare Provider Details

I. General information

NPI: 1558651109
Provider Name (Legal Business Name): JEREMY RYAN FURNISS OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2011
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 8TH ST NW
WASHINGTON DC
20011-7909
US

IV. Provider business mailing address

4101 8TH ST NW
WASHINGTON DC
20011-7909
US

V. Phone/Fax

Practice location:
  • Phone: 202-656-2118
  • Fax:
Mailing address:
  • Phone: 202-656-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOT0100006766
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number0119005205
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License NumberOTR2083
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: