MEDICARE: JOSHUA COLE FUNK MSOTR/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	0119003730	VA

General Provider Information

NPI Number	:	1346548278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA COLE FUNK MSOTR/L

Provider Business Mailing Address
First Line	:	5618 BURNAGE CT
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-4051
Country	:	US
Telephone Number	:	804-539-1835
Fax Number	:

Provider Business Practice Location Address
First Line	:	5618 BURNAGE CT
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-4051
Country	:	US
Telephone Number	:	804-539-1835
Fax Number	:

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

Provider Enumeration Date	:	03/01/2011
Last Update Date	:	03/01/2011

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