=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770478117
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNA HARE MPH, OTD, ORT/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PO BOX 149
-----------------------------------------------------
City | BELLE HAVEN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23306-0149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-442-5222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18415 BELOTE LN
-----------------------------------------------------
City | ONANCOCK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23417-2896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-678-2661
-----------------------------------------------------
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 | 0119010962
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------