Provider Demographics
NPI:1073341251
Name:ANDERSON, JOURDAN LYNN (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:JOURDAN
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:JOURDAN
Other - Middle Name:LYNN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13871 N LODORE RD
Mailing Address - Street 2:
Mailing Address - City:AMELIA COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23002-4546
Mailing Address - Country:US
Mailing Address - Phone:443-758-5633
Mailing Address - Fax:
Practice Address - Street 1:13871 N LODORE RD
Practice Address - Street 2:
Practice Address - City:AMELIA COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23002-4546
Practice Address - Country:US
Practice Address - Phone:443-758-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119010466225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist