Individual
MS. JORDAN HENNESSEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
6401 AUBURN DR, VIRGINIA BEACH, VA 23464-3601
(757) 420-2512
Mailing address
3516 ARGO CT, VIRGINIA BEACH, VA 23453-1974
(804) 310-6853
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131001709
VA
Other
Enumeration date
12/15/2017
Last updated
12/15/2017
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