Individual
MRS. PHYLLIS R ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L, CHT, CLT
Contact information
Practice address
11712 JEFFERSON AVE, SUITE D, NEWPORT NEWS, VA 23606-4406
(757) 595-4880
(757) 595-4886
Mailing address
600 KANAWAH RUN, YORKTOWN, VA 23693-2780
(757) 595-4880
(757) 595-4886
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
0119002028
VA
225XH1200X
Hand Occupational Therapist
Primary
0119002028
VA
225XH1300X
Human Factors Occupational Therapist
0119002028
VA
225XN1300X
Neurorehabilitation Occupational Therapist
0119002028
VA
225XP0200X
Pediatric Occupational Therapist
0119002028
VA
226300000X
Kinesiotherapist
0119002028
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008948721
—
VA
01
—
2062541
MAIL HANDLERS BENIFITS
VA
01
—
2101706
ALLIANCE PPO
VA
01
—
462361
ANTHEM BC/BS
VA
01
—
70510
VETRI SYSTEMS
VA
01
—
7202455
AETNA
VA
01
—
P00204753
MEDICARE RAILROAD
VA
Enumeration date
04/04/2006
Last updated
06/09/2008
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