Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 225XH1200X | VA |
N | 225XH1200X | Occupational Therapist - Hand | 0119001154 | VA |
NPI | 1043488794 |
---|---|
Provider Name | Ruth Grantham Tubb |
First Address | Virginia Beach, VA 23462-1832 |
Second Address | Norfolk, VA 23502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2008 |
Last Update Date | 23/07/2018 |