MEDICARE: MRS. KASEY AUDRA DYER HESTER MASTER OF OCCUPATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	3068	TN
2	225X00000X	Occupational Therapist	0119004522	VA

General Provider Information

NPI Number	:	1750479945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KASEY AUDRA DYER HESTER MASTER OF OCCUPATION

Provider Business Mailing Address
First Line	:	4560 SOUTH BLVD
Second Line	:	SUITE 310
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1160
Country	:	US
Telephone Number	:	757-490-3223
Fax Number	:

Provider Business Practice Location Address
First Line	:	4560 SOUTH BLVD
Second Line	:	SUITE 310
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1160
Country	:	US
Telephone Number	:	757-490-3223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	03/10/2008

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