Provider Demographics
NPI:1770565426
Name:LE, JENNIFER LYNN (OTR L)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:LE
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:LIPTRAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR L
Mailing Address - Street 1:421 CHATHAM SQUARE OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405
Mailing Address - Country:US
Mailing Address - Phone:540-373-3031
Mailing Address - Fax:540-373-9174
Practice Address - Street 1:2800 WELLFORD STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-373-6320
Practice Address - Fax:540-373-6385
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003403225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA147197OtherANTHEM BCBS
2129209OtherMAMSI
VA005756O07Medicare ID - Type Unspecified