Healthcare Provider Details

I. General information

NPI: 1578788980
Provider Name (Legal Business Name): YOLUNDA G DOCKETT OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YOLUNDA G SMOOT OTD, OTR/L

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 11/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14906 JEFFERSON DAVIS HWY
WOODBRIDGE VA
22191-4016
US

IV. Provider business mailing address

14906 JEFFERSON DAVIS HWY
WOODBRIDGE VA
22191-4016
US

V. Phone/Fax

Practice location:
  • Phone: 571-248-6556
  • Fax:
Mailing address:
  • Phone: 571-248-6556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number0119004618
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119004618
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: