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General NPI Number Information
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NPI Number | 1043766637
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Entity Type | Organization
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Legal Business Name | THE WRITE OT
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 3420 PUMP RD #172
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City | HENRICO
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State | VA
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Zip | 23233-1111
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Country | US
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Telephone | 804-551-2334
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Fax |
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Provider Business Mailing Address
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Address Line | 3420 PUMP ROAD #172
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City | HENRICO
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State | VA
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Zip | 23233
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ILYSE ANN CANFIELD
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Credential | OT/L
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Telephone | 804-551-2334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119004864
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License Number State | VA
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