MEDICARE: JEANINE MILLER ADAMS 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	225XH1200X	Hand Occupational Therapist	0119005903	VA

General Provider Information

NPI Number	:	1790027696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANINE MILLER ADAMS OTR/L

Provider Business Mailing Address
First Line	:	7536 GARDNER PARK DR STE 7536
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3414
Country	:	US
Telephone Number	:	703-754-4770
Fax Number	:	703-754-4435

Provider Business Practice Location Address
First Line	:	7536 GARDNER PARK DR STE 7536
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3414
Country	:	US
Telephone Number	:	703-754-4770
Fax Number	:	703-754-4435

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

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	03/19/2013

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