=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255519005
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALLY WALKER-CRUDEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2008
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 E PICCADILLY ST STE 11&14
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22601-3971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-407-3422
-----------------------------------------------------
Fax | 877-407-4329
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10800 MIDLOTHIAN TPKE SUITE 311
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235-4724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | 0119005630
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------