Healthcare Provider Details

I. General information

NPI: 1164511291
Provider Name (Legal Business Name): PAULA J GAUDIO OT, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 VOLVO PKWY STE 300
CHESAPEAKE VA
23320-1610
US

IV. Provider business mailing address

230 CLEARFIELD AVE STE 124
VIRGINIA BEACH VA
23462-1832
US

V. Phone/Fax

Practice location:
  • Phone: 757-321-3300
  • Fax: 577-436-0781
Mailing address:
  • Phone: 757-321-3383
  • Fax: 813-558-6415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number0119008016
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT1598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: