Organization
GENESIS REHAB SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHARISE LILLIAN WILSON-HAMMOND OTR/L (OTR/L)
(757) 463-0670
Entity
Organization
Contact information
Practice address
809 ADDISON CT, VIRGINIA BEACH, VA 23462-6904
(757) 463-0670
Mailing address
809 ADDISON CT, VIRGINIA BEACH, VA 23462-6904
(757) 463-0670
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
0119004820
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119004820
VIRGINIA STATE OCCUPATIONAL THERAPY LICENSE
VA
Enumeration date
04/21/2009
Last updated
04/21/2009
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