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General NPI Number Information
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NPI Number | 1427399302
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Entity Type | Individual
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Provider Name | VANESSA LAURE FASSIE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/02/2013
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Last Update Date | 03/02/2013
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Provider Practice Location Address
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Address Line | 4435 PHEASANT RIDGE RD
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City | ROANOKE
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State | VA
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Zip | 24014-5285
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Country | US
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Telephone | 540-904-4571
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 RIDGECREST DR
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City | ROANOKE
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State | VA
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Zip | 24019-6243
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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 | 0119005872
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License Number State | VA
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