Provider Demographics
NPI:1386437267
Name:JENKINS, GENESIS (COTA/L)
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:
Last Name:JENKINS
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 1:3990 BRUSSELS WAY
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-7637
Mailing Address - Country:US
Mailing Address - Phone:571-292-6590
Mailing Address - Fax:
Practice Address - Street 1:4100 LAFAYETTE CENTER DR STE 103
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1234
Practice Address - Country:US
Practice Address - Phone:571-297-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant