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Organization
TIDEWATER THERAPY FOR CHILDREN, PC
Active
Organization
TIDEWATER THERAPY FOR CHILDREN, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA ML DUPREE BS (OFFICE/INSURANCE MANAGER)
(757) 488-2864
Entity
Organization
Contact information
Practice address
4016 RAINTREE RD, SUITE 240, CHESAPEAKE, VA 23321-3700
(757) 488-2864
(757) 488-4735
Mailing address
4016 RAINTREE RD, SUITE 240, CHESAPEAKE, VA 23321-3700
(757) 488-2864
(757) 488-4735
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
194324
ANTHEM BC & HK ST PROV #
VA
01
—
57442
OPTIMA ST PROVIDER #
VA
Enumeration date
07/14/2006
Last updated
08/22/2020
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