Basic Information
Provider Information
NPI: 1912400227
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOOVER
FirstName: JAMIE
MiddleName: PAUL
NamePrefix: MR.
NameSuffix:  
Credential: MOT OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 209 STACEY CT
Address2:  
City: CULPEPER
State: VA
PostalCode: 227012055
CountryCode: US
TelephoneNumber: 8142432590
FaxNumber:  
Practice Location
Address1: 450 RADIO LN
Address2:  
City: CULPEPER
State: VA
PostalCode: 227011521
CountryCode: US
TelephoneNumber: 5408253677
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/13/2018
LastUpdateDate: 03/13/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X0119003971VAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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