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General NPI Number Information
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NPI Number | 1912421538
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Entity Type | Individual
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Provider Name | JORDAN RAE KING OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/26/2017
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 625 PINEY FOREST RD STE 407
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City | DANVILLE
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State | VA
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Zip | 24540-2870
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Country | US
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Telephone | 434-799-7732
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Fax |
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Provider Business Mailing Address
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Address Line | 13400 S ROUTE 59 STE 116-326
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City | PLAINFIELD
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State | IL
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Zip | 60585-5826
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Country | US
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Telephone | 815-592-1123
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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 | 5201009881
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License Number State | MI
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