Basic Information
| Provider Information | |||||||||
| NPI: | 1619445095 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VERCHER | ||||||||
| FirstName: | JODY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | COTA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SMITH | ||||||||
| OtherFirstName: | JODY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | COTA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 149 CONTRAIL DR | ||||||||
| Address2: | |||||||||
| City: | KEARNEYSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254302899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133053453 | ||||||||
| FaxNumber: | 8552328604 | ||||||||
| Practice Location | |||||||||
| Address1: | 149 CONTRAIL DR | ||||||||
| Address2: | |||||||||
| City: | KEARNEYSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254302899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133053453 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2018 | ||||||||
| LastUpdateDate: | 11/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 213286 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 224Z00000X | C2165 | WV | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 224Z00000X | 0131001854 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.