Active NPI
Adrienn Jackson Grimsley, OTR/L
- Occupational Therapist
- Leesburg, VA
National Provider Identifier
1194489567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 4623
- Practice address
- 235 Old Waterford Rd NW
Leesburg, VA 20176-2117 - Phone
- (703) 779-3733
- NPI assigned
- Oct 22, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 4623 | SC | Primary |
Addresses
Primary practice location
235 Old Waterford Rd NW
Leesburg, VA 20176-2117
Mailing address
1228 F Ave
West Columbia, SC 29169-6131
Phone (803) 917-1881
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4623 | SC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634860800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634860800000",
"number": "1194489567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1228 F AVE",
"city": "WEST COLUMBIA",
"state": "SC",
"postal_code": "291696131",
"telephone_number": "803-917-1881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "235 OLD WATERFORD RD NW",
"city": "LEESBURG",
"state": "VA",
"postal_code": "201762117",
"telephone_number": "703-779-3733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIMSLEY",
"first_name": "ADRIENN",
"middle_name": "JACKSON",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-10-22",
"last_updated": "2021-10-22",
"certification_date": "2021-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "SC",
"license": "4623",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leesburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.