NPIMap

Individual provider Active NPI

Jennifer Faherty, MOT, OTR/L

  • Occupational Therapist
  • Woodbridge, VA
National Provider Identifier
1396115010
Registry record updated Oct 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
0119006741 Issued in VA
Practice address
2235 Tacketts Mill Dr
Suite C
Woodbridge, VA 22192-3036
Phone
(703) 491-1044
Fax
(703) 491-2044
NPI assigned
Oct 7, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 0119006741 VA Primary

Addresses

Primary practice location

2235 Tacketts Mill Dr
Suite C
Woodbridge, VA 22192-3036

Mailing address

2235 Tacketts Mill Dr
Suite C
Woodbridge, VA 22192-3036
Phone (703) 491-1044

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

LicenseStateTypeSpecialty
0119006741VAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Achievements, LLC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444176000000",
    "number": "1396115010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2235 TACKETTS MILL DR",
            "address_2": "SUITE C",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221923036",
            "telephone_number": "703-491-1044",
            "fax_number": "703-491-2044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 TACKETTS MILL DR",
            "address_2": "SUITE C",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221923036",
            "telephone_number": "703-491-1044",
            "fax_number": "703-491-2044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAHERTY",
        "first_name": "JENNIFER",
        "credential": "MOT, OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-07",
        "last_updated": "2015-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "VA",
            "license": "0119006741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.