Healthcare Provider Details

I. General information

NPI: 1578878609
Provider Name (Legal Business Name): KARA RAJANA JEFFREY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 W COURT ST
WOODSTOCK VA
22664-1303
US

IV. Provider business mailing address

517 WEST COURT STREET
WOODSTOCK VA
22664
US

V. Phone/Fax

Practice location:
  • Phone: 540-459-4381
  • Fax:
Mailing address:
  • Phone: 540-459-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number0119003336
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: