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NPI Code Detail

MEDICARE: JAN TRITTIPOE HOGUE COTA/L

MEDICARE: JAN TRITTIPOE HOGUE COTA/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
1224Z00000XOccupational Therapy Assistant0131002054VA

General Provider Information

NPI Number : 1891496766
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAN TRITTIPOE HOGUE COTA/L
Provider Business Mailing Address
First Line : 4905 DICKENS RD STE 106
Second Line :
City : RICHMOND
State : VA
Zip : 23230-1953
Country : US
Telephone Number : 804-638-5047
Fax Number :
Provider Business Practice Location Address
First Line : 11901 REEDY BRANCH RD
Second Line :
City : CHESTERFIELD
State : VA
Zip : 23838-4235
Country : US
Telephone Number : 804-638-5047
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2023
Last Update Date : 03/16/2023

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