MEDICARE: TIA JAVIER M.A. M.S. , CCC-SLP

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	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist	2204000336	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	:	1326600347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIA JAVIER M.A. M.S. , CCC-SLP

Provider Business Mailing Address
First Line	:	6740 FOREST HILL AVE STE 101
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-1847
Country	:	US
Telephone Number	:	804-505-0251
Fax Number	:	804-800-4251

Provider Business Practice Location Address
First Line	:	6740 FOREST HILL AVE STE 101
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-1847
Country	:	US
Telephone Number	:	804-505-0251
Fax Number	:	804-800-4251

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

Provider Enumeration Date	:	06/29/2019
Last Update Date	:	03/15/2021

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