1316187107 NPI number — JANELLE GOCHENOUR OTR/L

Table of content: JANELLE GOCHENOUR OTR/L (NPI 1316187107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316187107 NPI number — JANELLE GOCHENOUR OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOCHENOUR
Provider First Name:
JANELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316187107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORGE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23127-0280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-566-3300
Provider Business Mailing Address Fax Number:
757-566-8977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 POINT O'WOODS RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23188-7052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-566-3300
Provider Business Practice Location Address Fax Number:
757-566-8977
Provider Enumeration Date:
03/06/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  0119000480 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 49-6679 . This is a "MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 49-7850-1 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 194410 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 45084 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".