MEDICARE: MS. ELENA PICKFORD 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	0119005322	VA

General Provider Information

NPI Number	:	1134418817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELENA PICKFORD OTR/L

Provider Business Mailing Address
First Line	:	6623 HOLFORD LN
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-2909
Country	:	US
Telephone Number	:	703-866-6032
Fax Number	:

Provider Business Practice Location Address
First Line	:	7001A LOISDALE RD
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22150-1904
Country	:	US
Telephone Number	:	703-971-0602
Fax Number	:

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

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	07/19/2011

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