Organization
EASTERN SHORE COMMUNITY SERVICES BOARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH COOLEY (REIMBURSEMENT COORDINATOR)
(757) 442-3636
Entity
Organization
Contact information
Practice address
15150 MERRY CAT LANE, BELLE HAVEN, VA 23306
(757) 442-7599
Mailing address
PO BOX 453, NASSAWADOX, VA 23413-0453
(757) 442-7599
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
VA
225XP0200X
Pediatric Occupational Therapist
—
VA
235Z00000X
Speech-Language Pathologist
Primary
—
VA
Other
Enumeration date
09/13/2007
Last updated
01/21/2008
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