Healthcare Provider Details

I. General information

NPI: 1144144411
Provider Name (Legal Business Name): JENNIFER DUNNAVANT OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIE DUNNAVANT OTD, OTR/L

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8270 WILLOW OAKS CORPORATE DR
FAIRFAX VA
22031-4511
US

IV. Provider business mailing address

4404 VERMONT AVE
ALEXANDRIA VA
22304-4924
US

V. Phone/Fax

Practice location:
  • Phone: 210-393-3640
  • Fax:
Mailing address:
  • Phone: 210-393-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119011499
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: