Healthcare Provider Details

I. General information

NPI: 1770001521
Provider Name (Legal Business Name): KW PEDS & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 RAINTREE RD STE 100B
CHESAPEAKE VA
23321-3741
US

IV. Provider business mailing address

1317 KING ARTHUR CT
CHESAPEAKE VA
23323-2819
US

V. Phone/Fax

Practice location:
  • Phone: 757-630-9236
  • Fax:
Mailing address:
  • Phone: 757-630-9236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHERITA N QUICK-WILLIAMS
Title or Position: DIRECTOR/ OWNER
Credential:
Phone: 757-630-0090