Organization
TIDEWATER THERAPY FOR CHILDREN, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA M 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
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004979061
—
VA
Enumeration date
08/18/2006
Last updated
04/10/2026
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