Healthcare Provider Details

I. General information

NPI: 1013410307
Provider Name (Legal Business Name): LITTLE KESWICK SCHOOL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LITTLE KESWICK LN
KESWICK VA
22947-2406
US

IV. Provider business mailing address

PO BOX 24
KESWICK VA
22947-0024
US

V. Phone/Fax

Practice location:
  • Phone: 434-295-0457
  • Fax:
Mailing address:
  • Phone: 434-295-0457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateVA

VIII. Authorized Official

Name: MELISSA NORDER
Title or Position: BUSINESS MANAGER/COMPTROLLER
Credential:
Phone: 434-295-0457