MEDICARE: MRS. PENNIE MARIE NAKASHIMA

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	0119004359	VA

General Provider Information

NPI Number	:	1134347644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PENNIE MARIE NAKASHIMA

Provider Business Mailing Address
First Line	:	5879 WOODFIELD ESTATES DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-1865
Country	:	US
Telephone Number	:	703-313-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	5879 WOODFIELD ESTATES DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-1865
Country	:	US
Telephone Number	:	703-313-0808
Fax Number	:

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

Provider Enumeration Date	:	04/22/2007
Last Update Date	:	07/08/2007

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