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General NPI Number Information
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NPI Number | 1982208781
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Entity Type | Organization
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Legal Business Name | INNOVATIVE THERAPY LLC
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 900 COMMONWEALTH PLACE, SUITE 365
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464
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Country | US
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Telephone | 757-373-2023
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Fax | 757-447-0139
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Provider Business Mailing Address
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Address Line | 900 COMMONWEALTH PLACE, SUITE 365
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464
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Country | US
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Telephone | 757-373-2023
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Fax | 757-447-0139
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Authorized Official
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Title or Position | OWNER/MANAGING PARTNER
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Name | LINDSEY GRACE GLEASON
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Credential | M.S.CCC-SLP
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Telephone | 757-450-0977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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