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NPI Code Detail

MEDICARE: MRS. JENA GROSS NORTHEN MS, OTR/L, BCN, SIPT

MEDICARE: MRS. JENA GROSS NORTHEN MS, OTR/L, BCN, SIPT
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
1225X00000XOccupational Therapist0119001176VA

General Provider Information

NPI Number : 1174758460
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENA GROSS NORTHEN MS, OTR/L, BCN, SIPT
Provider Business Mailing Address
First Line : 4840 WALLER RD
Second Line : SUITE 200
City : RICHMOND
State : VA
Zip : 23230-2912
Country : US
Telephone Number : 804-893-5010
Fax Number : 804-412-8105
Provider Business Practice Location Address
First Line : 4840 WALLER RD
Second Line : SUITE 200
City : RICHMOND
State : VA
Zip : 23230-2912
Country : US
Telephone Number : 804-893-5010
Fax Number : 804-412-8105
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2009
Last Update Date : 01/10/2016

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