Provider Demographics
NPI:1902968225
Name:JETER, EMILY C (OT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:C
Last Name:JETER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 CONNECTICUT AVE NW STE 417
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-5458
Mailing Address - Country:US
Mailing Address - Phone:202-528-7223
Mailing Address - Fax:202-293-2262
Practice Address - Street 1:1025 CONNECTICUT AVE NW STE 417
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5458
Practice Address - Country:US
Practice Address - Phone:025-287-2232
Practice Address - Fax:202-293-2296
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT616225X00000X, 174400000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC491326Medicare PIN