Basic Information
| Provider Information | |||||||||
| NPI: | 1174044317 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEETSCREEK | ||||||||
| FirstName: | ALLYSON | ||||||||
| MiddleName: | PAIGE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5604 VIRGINIA BEACH BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234625631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574555000 | ||||||||
| FaxNumber: | 7573194142 | ||||||||
| Practice Location | |||||||||
| Address1: | 5604 VIRGINIA BEACH BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234625631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574555000 | ||||||||
| FaxNumber: | 7574319414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2017 | ||||||||
| LastUpdateDate: | 11/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.