Healthcare Provider Details

I. General information

NPI: 1265773832
Provider Name (Legal Business Name): MARILYN EDMONDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E LEE HWY
NEW MARKET VA
22844-3103
US

IV. Provider business mailing address

315 E LEE HWY
NEW MARKET VA
22844-3103
US

V. Phone/Fax

Practice location:
  • Phone: 540-740-8041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number0119005627
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: