=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306213665
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOVING FOWARD REHAB
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2015
-----------------------------------------------------
Last Update Date | 08/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3594 WESTOVER DR
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24541-5472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-251-2699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3594 WESTOVER DR
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24541-5472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-251-2699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | DR. JILL C HAMLIN
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 434-251-2699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 0119003296
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------