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General NPI Number Information
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NPI Number | 1174388219
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Entity Type | Individual
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Provider Name | TIPPI GERON OTD
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Gender | Female
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 4445 CORPORATION LN STE 264
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3671
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Country | US
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Telephone | 703-992-3425
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Fax |
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Provider Business Mailing Address
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Address Line | 2445 FREETOWN DR
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City | RESTON
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State | VA
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Zip | 20191-2511
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Country | US
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Telephone | 703-232-6064
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119006563
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License Number State | VA
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