Healthcare Provider Details

I. General information

NPI: 1437420726
Provider Name (Legal Business Name): LAUREN MARIE JAMIESON OT/S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 PROVIDENCE RD SUITE 80
VIRGINIA BEACH VA
23464-4128
US

IV. Provider business mailing address

5301 PROVIDENCE RD SUITE 80
VIRGINIA BEACH VA
23464-4128
US

V. Phone/Fax

Practice location:
  • Phone: 757-467-4604
  • Fax: 757-467-2716
Mailing address:
  • Phone: 757-467-4604
  • Fax: 757-467-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number274984
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: