MEDICARE: JENNIFER-ANN SALES COATES OTD

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	056008044	IL
2	225X00000X	Occupational Therapist	0119010428	VA

General Provider Information

NPI Number	:	1639374739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER-ANN SALES COATES OTD

Provider Business Mailing Address
First Line	:	PO BOX 715868
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19171-5868
Country	:	US
Telephone Number	:	804-915-1910
Fax Number	:	804-968-1803

Provider Business Practice Location Address
First Line	:	20041 RIVERSIDE COMMONS PLZ
Second Line	:
City	:	ASHBURN
State	:	VA
Zip	:	20147-5151
Country	:	US
Telephone Number	:	703-574-3010
Fax Number	:	703-810-5323

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	06/17/2024

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