=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477074508
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORDAN PAIGE GIARRAPUTO OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2017
-----------------------------------------------------
Last Update Date | 06/28/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1508 VOLVO PKWY
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-8293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-648-3070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8565 TIDEWATER DR APT B
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23503-5550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-325-3101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 0119007386
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------