Provider Demographics
NPI:1902115421
Name:GILBERT, JANE REYNOLDS (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:REYNOLDS
Last Name:GILBERT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 BLUE GRASS TRL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VA
Mailing Address - Zip Code:24128-3574
Mailing Address - Country:US
Mailing Address - Phone:540-544-3089
Mailing Address - Fax:
Practice Address - Street 1:1114 BLUE GRASS TRL
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VA
Practice Address - Zip Code:24128-3574
Practice Address - Country:US
Practice Address - Phone:540-544-3089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA256994224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant