MEDICARE: MS. REBECCA L DALTON M.S.

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	235Z00000X	Speech-Language Pathologist	2202007167	VA

General Provider Information

NPI Number	:	1821422437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA L DALTON M.S.

Provider Business Mailing Address
First Line	:	2205 COVERED BRIDGE WAY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2101
Country	:	US
Telephone Number	:	757-619-7411
Fax Number	:

Provider Business Practice Location Address
First Line	:	2205 COVERED BRIDGE WAY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2101
Country	:	US
Telephone Number	:	757-619-7411
Fax Number	:

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

Provider Enumeration Date	:	08/30/2013
Last Update Date	:	09/26/2013

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