Individual
JESSICA CARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
612 KELLAM RD, VIRGINIA BEACH, VA 23462-2031
(607) 434-7486
Mailing address
612 KELLAM RD, VIRGINIA BEACH, VA 23462-2031
(607) 434-7486
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119005741
VA
Other
Enumeration date
10/06/2014
Last updated
10/06/2014
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