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General NPI Number Information
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NPI Number | 1255569703
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Entity Type | Organization
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Legal Business Name | PERRY POINT VAMC
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 06/23/2009
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Provider Practice Location Address
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Address Line | 0 AVENUE D BUILDING 80H, ROOM 201
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City | PERRY POINT
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State | MD
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Zip | 21902-1003
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Country | US
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Telephone | 410-642-2411
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Fax |
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Provider Business Mailing Address
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Address Line | 66 COUNTRY DR
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City | LEOLA
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State | PA
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Zip | 17540-1717
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Country | US
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Telephone | 717-656-0529
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Fax |
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Authorized Official
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Title or Position | OT INTERN
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Name | MISS JACQUELINE OLIVIA TROTTER
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Credential | B.S.
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Telephone | 410-642-2411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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