Provider Demographics
NPI:1124619531
Name:HUGENTOBER, MARK DANIEL (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DANIEL
Last Name:HUGENTOBER
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GINGER ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-6903
Mailing Address - Country:US
Mailing Address - Phone:540-903-0722
Mailing Address - Fax:
Practice Address - Street 1:105 GINGER ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-6903
Practice Address - Country:US
Practice Address - Phone:540-903-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004698225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist