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NPI Code Detail

MEDICARE: MARVA MARIE DAVIS REID COTA/L

MEDICARE: MARVA MARIE DAVIS REID COTA/L
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
1224Z00000XOccupational Therapy Assistant0131001365VA

General Provider Information

NPI Number : 1588265524
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARVA MARIE DAVIS REID COTA/L
Provider Business Mailing Address
First Line : 1604 OLD DONATION PKWY
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-3063
Country : US
Telephone Number : 757-408-5505
Fax Number :
Provider Business Practice Location Address
First Line : 1604 OLD DONATION PKWY
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-3063
Country : US
Telephone Number : 757-937-7600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2020
Last Update Date : 03/17/2021

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