MEDICARE: MRS. SALLY MINNICH WOOLDRIDGE OT

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	225XH1200X	Hand Occupational Therapist	0119000085	VA

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

General Provider Information

NPI Number	:	1326154071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SALLY MINNICH WOOLDRIDGE OT

Provider Business Mailing 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

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	:	08/22/2006
Last Update Date	:	06/09/2008

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