Provider Demographics
NPI:1174758460
Name:NORTHEN, JENA GROSS (MS, OTR/L, BCN, SIPT)
Entity type:Individual
Prefix:MRS
First Name:JENA
Middle Name:GROSS
Last Name:NORTHEN
Suffix:
Gender:F
Credentials:MS, OTR/L, BCN, SIPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 WALLER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2912
Mailing Address - Country:US
Mailing Address - Phone:804-893-5010
Mailing Address - Fax:804-412-8105
Practice Address - Street 1:4840 WALLER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2912
Practice Address - Country:US
Practice Address - Phone:804-893-5010
Practice Address - Fax:804-412-8105
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2016-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001176225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist