Healthcare Provider Details

I. General information

NPI: 1558860916
Provider Name (Legal Business Name): FRANCES ELIZABETH DICKINSON OTL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6099 T C WALKER RD
GLOUCESTER VA
23061-4403
US

IV. Provider business mailing address

6529 SCHLEY LANE
SCHLEY VA
23154
US

V. Phone/Fax

Practice location:
  • Phone: 803-693-7880
  • Fax:
Mailing address:
  • Phone: 804-694-4322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119001504
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: