Healthcare Provider Details

I. General information

NPI: 1164848016
Provider Name (Legal Business Name): TARESSA HURD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N JEFFERSON ST
ROANOKE VA
24016-1427
US

IV. Provider business mailing address

3804 SAUNDERS RD
VINTON VA
24179-6323
US

V. Phone/Fax

Practice location:
  • Phone: 540-343-3484
  • Fax: 540-343-3197
Mailing address:
  • Phone: 540-529-5529
  • Fax: 276-293-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119004149
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: