Healthcare Provider Details

I. General information

NPI: 1881933406
Provider Name (Legal Business Name): SUSAN HARGROVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

897 SALVIA RD
NEWTOWN VA
23126-2024
US

IV. Provider business mailing address

897 SALVIA RD
NEWTOWN VA
23126-2024
US

V. Phone/Fax

Practice location:
  • Phone: 804-769-4084
  • Fax:
Mailing address:
  • Phone: 804-769-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131001009
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: