Healthcare Provider Details

I. General information

NPI: 1437606092
Provider Name (Legal Business Name): DEBORAH OPSAL ST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 RIVERMONT AVE OUTPATIENT REHAB ADMINISTRATION
LYNCHBURG VA
24503
US

IV. Provider business mailing address

3300 RIVERMONT AVE OUTPATIENT REHAB ADMINISTRATION
LYNCHBURG VA
24503
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5032
  • Fax:
Mailing address:
  • Phone: 434-200-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202005442
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: