MEDICARE: MRS. ALLISON VARGAS KENNEDY OTR/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
1	225XP0200X	Pediatric Occupational Therapist	OT 12943	FL
2	225X00000X	Occupational Therapist	OT 12943	FL
3	225X00000X	Occupational Therapist	0119006447	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
2	Z152T	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639358997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLISON VARGAS KENNEDY OTR/L

Provider Business Mailing Address
First Line	:	1377 MOTOR PKWY STE 307
Second Line	:
City	:	ISLANDIA
State	:	NY
Zip	:	11749-5258
Country	:	US
Telephone Number	:	631-580-5200
Fax Number	:	631-580-5222

Provider Business Practice Location Address
First Line	:	1157 FIRST COLONIAL RD STE 201
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2432
Country	:	US
Telephone Number	:	757-481-0052
Fax Number	:	757-481-1099

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

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	06/03/2019

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Directions to “ MRS. ALLISON VARGAS KENNEDY OTR/L” Practice Location

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