Individual
MS. KELLEY TERESA YATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. OTR/L
Contact information
Practice address
5301 PROVIDENCE RD, SUITE 80, VIRGINIA BEACH, VA 23464-4128
(757) 467-4604
(757) 467-2716
Mailing address
5301 PROVIDENCE RD, SUITE 80, VIRGINIA BEACH, VA 23464-4128
(757) 467-4604
(757) 467-2716
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119005089
VA
225X00000X
Occupational Therapist
16255
CA
225X00000X
Occupational Therapist
8647
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
324887401
—
TX
05
—
7210315
—
NC
01
—
892T13
BLUE CROSS BLUE SHIELD
TX
Enumeration date
02/08/2012
Last updated
06/14/2016
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