MEDICARE: JESSICA EUN CHANG M.S., OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0119007192	VA

General Provider Information

NPI Number	:	1063944486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA EUN CHANG M.S., OTR/L

Provider Business Mailing Address
First Line	:	9621 LINDENBROOK ST
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-1120
Country	:	US
Telephone Number	:	703-470-7153
Fax Number	:

Provider Business Practice Location Address
First Line	:	4310 FOREST HILL DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-5680
Country	:	US
Telephone Number	:	703-278-1001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	04/03/2017

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