Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 0131001226 | VA |
NPI | 1023422912 |
---|---|
Provider Name | Tess Mitchell |
First Address | Virginia Beach, VA 23452-1160 |
Second Address | Virginia Beach, VA 23452-1160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2014 |
Last Update Date | 18/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0131001226 | STATE LICENSE (01) | VA |