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General NPI Number Information
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NPI Number | 1235959180
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Entity Type | Individual
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Provider Name | MESA ENGELHARDT OTD, OTR/L, RYT-200
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Gender | Female
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 2220 EXECUTIVE DR
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City | HAMPTON
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State | VA
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Zip | 23666-6607
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Country | US
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Telephone | 843-902-9098
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Fax |
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Provider Business Mailing Address
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Address Line | 3114 HERBERT ST
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City | NORFOLK
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State | VA
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Zip | 23513-2302
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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 |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State |
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