Healthcare Provider Details

I. General information

NPI: 1639795172
Provider Name (Legal Business Name): KAREN OCHOA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2020
Last Update Date: 06/21/2020
Certification Date: 06/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 4TH ST SE APT 34
CHARLOTTESVILLE VA
22902-5689
US

IV. Provider business mailing address

312 4TH ST SE APT 34
CHARLOTTESVILLE VA
22902-5689
US

V. Phone/Fax

Practice location:
  • Phone: 321-806-9086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204000473
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: