Healthcare Provider Details

I. General information

NPI: 1639358997
Provider Name (Legal Business Name): ALLISON VARGAS KENNEDY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON REBECCA VARGAS OTR/L

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 FIRST COLONIAL RD STE 201
VIRGINIA BEACH VA
23454-2432
US

IV. Provider business mailing address

1377 MOTOR PKWY STE 307
ISLANDIA NY
11749-5258
US

V. Phone/Fax

Practice location:
  • Phone: 757-481-0052
  • Fax: 757-481-1099
Mailing address:
  • Phone: 631-580-5200
  • Fax: 631-580-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 12943
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 12943
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119006447
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: