Healthcare Provider Details

I. General information

NPI: 1972069490
Provider Name (Legal Business Name): MRS. MICHELLE ALECE HOPKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CLOCKTOWER RIDGE DR
WINCHESTER VA
22603-3878
US

IV. Provider business mailing address

2532 DETOUR ROAD
GREAT CACAPON WV
25422
US

V. Phone/Fax

Practice location:
  • Phone: 540-431-2800
  • Fax:
Mailing address:
  • Phone: 304-258-7723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131002139
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberC2255
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberA02732
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: