MEDICARE: DR. YOLUNDA G DOCKETT OTD, 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	225XG0600X	Gerontology Occupational Therapist	0119004618	VA
2	225XP0200X	Pediatric Occupational Therapist	0119004618	VA

General Provider Information

NPI Number	:	1578788980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOLUNDA G DOCKETT OTD, OTR/L

Provider Business Mailing Address
First Line	:	14906 JEFFERSON DAVIS HWY
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-4016
Country	:	US
Telephone Number	:	571-248-6556
Fax Number	:

Provider Business Practice Location Address
First Line	:	14906 JEFFERSON DAVIS HWY
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-4016
Country	:	US
Telephone Number	:	571-248-6556
Fax Number	:

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	11/10/2012

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