Healthcare Provider Details

I. General information

NPI: 1457576985
Provider Name (Legal Business Name): MARY ROBINSON HULL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 SOUTH BLVD
VIRGINIA BEACH VA
23452-1160
US

IV. Provider business mailing address

116 ASH HILL LNDG
CHESAPEAKE VA
23322-7190
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-3223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119001309
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: