Healthcare Provider Details

I. General information

NPI: 1982216487
Provider Name (Legal Business Name): TIDEWATER VISION OCCUPATIONAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 MAGNOLIA AVE
NORFOLK VA
23508-1153
US

IV. Provider business mailing address

1441 MAGNOLIA AVE
NORFOLK VA
23508-1153
US

V. Phone/Fax

Practice location:
  • Phone: 757-985-7555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMBER N CHONSKY
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 757-985-7555