Healthcare Provider Details

I. General information

NPI: 1649877341
Provider Name (Legal Business Name): JAMIELYNN M BODMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 FESTIVAL PARK PLZ
CHESTER VA
23831-4449
US

IV. Provider business mailing address

1377 MOTOR PKWY STE 307
ISLANDIA NY
11749-5258
US

V. Phone/Fax

Practice location:
  • Phone: 804-930-8280
  • Fax: 804-930-8101
Mailing address:
  • Phone: 631-580-5200
  • Fax: 631-760-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119007686
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: