Healthcare Provider Details

I. General information

NPI: 1639499734
Provider Name (Legal Business Name): JESSICA NICHOLE SHIPMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 ALUM SPRING RD STE 101
FREDERICKSBURG VA
22401-8011
US

IV. Provider business mailing address

1329 ALUM SPRING RD STE 101
FREDERICKSBURG VA
22401-8011
US

V. Phone/Fax

Practice location:
  • Phone: 540-569-9820
  • Fax:
Mailing address:
  • Phone: 540-569-9820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119003746
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: