MEDICARE: MRS. PHYLLIS R ROSS OTR/L, CHT, CLT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0119002028	VA
2	225XH1200X	Hand Occupational Therapist	0119002028	VA
3	225XH1300X	Human Factors Occupational Therapist	0119002028	VA
4	225XN1300X	Neurorehabilitation Occupational Therapist	0119002028	VA
5	225XP0200X	Pediatric Occupational Therapist	0119002028	VA
6	226300000X	Kinesiotherapist	0119002028	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00204753	OTHER	VA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2101706	OTHER	VA	ALLIANCE PPO
3	462361	OTHER	VA	ANTHEM BC/BS
4	7202455	OTHER	VA	AETNA
5	2101706	OTHER	VA	MAMSI / GEHA
6	2062541	OTHER	VA	MAIL HANDLERS BENIFITS
8	70510	OTHER	VA	VETRI SYSTEMS

General Provider Information

NPI Number	:	1184686453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PHYLLIS R ROSS OTR/L, CHT, CLT

Provider Business Mailing Address
First Line	:	600 KANAWAH RUN
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-2780
Country	:	US
Telephone Number	:	757-595-4880
Fax Number	:	757-595-4886

Provider Business Practice Location Address
First Line	:	11712 JEFFERSON AVE
Second Line	:	SUITE D
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-4406
Country	:	US
Telephone Number	:	757-595-4880
Fax Number	:	757-595-4886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	06/09/2008

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