Healthcare Provider Details

I. General information

NPI: 1689287542
Provider Name (Legal Business Name): VICTORIA SANTOS OTD, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CENTERBROOKE LN STE 103
SUFFOLK VA
23434-8663
US

IV. Provider business mailing address

16803 NE 20TH ST
VANCOUVER WA
98684-6787
US

V. Phone/Fax

Practice location:
  • Phone: 757-774-5600
  • Fax:
Mailing address:
  • Phone: 360-448-0160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT61321300
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119011399
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT28002
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number350333
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: