Organization
REVITALIZE FUNCTION LLC
Active
Organization
REVITALIZE FUNCTION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMANDA BETH FIROVED PH.D., MOT, OTR/L (OWNER, CEO)
(757) 663-2056
Entity
Organization
Contact information
Practice address
712 WESTOVER AVE, NORFOLK, VA 23507-1623
(757) 663-2056
Mailing address
712 WESTOVER AVE, NORFOLK, VA 23507-1623
(757) 663-2056
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
09/02/2024
Last updated
09/02/2024
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