Healthcare Provider Details

I. General information

NPI: 1497274765
Provider Name (Legal Business Name): JAMIE CRISMAN MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FORDHAM DRIVE
VIRGINIA BEACH VA
23464
US

IV. Provider business mailing address

1400 FORDHAM DR
VIRGINIA BEACH VA
23464-5368
US

V. Phone/Fax

Practice location:
  • Phone: 757-361-3954
  • Fax:
Mailing address:
  • Phone: 757-361-3954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119-007482
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: