=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134632128
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEREK LEE RAMEY OTR/L
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2017
-----------------------------------------------------
Last Update Date | 11/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6548 BIRCHFIELD ROAD APT C
-----------------------------------------------------
City | WISE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24293-2429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-870-3693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2827
-----------------------------------------------------
City | WISE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24293-2827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-870-3693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 0119007088
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------