Healthcare Provider Details

I. General information

NPI: 1205169042
Provider Name (Legal Business Name): GLENDA RAPTIS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5372B OLD VIRGINIA STREET
URBANNA VA
23175
US

IV. Provider business mailing address

P.O. BOX 40
SALUDA VA
23149
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-6300
  • Fax: 757-539-0704
Mailing address:
  • Phone: 804-758-5250
  • Fax: 804-758-5183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119004484
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: