Basic Information
| Provider Information | |||||||||
| NPI: | 1750479945 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HESTER | ||||||||
| FirstName: | KASEY | ||||||||
| MiddleName: | AUDRA DYER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MASTER OF OCCUPATION | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DYER | ||||||||
| OtherFirstName: | KASEY | ||||||||
| OtherMiddleName: | AUDRA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MASTER OF OCCUPATION | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4560 SOUTH BLVD | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234521160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574903223 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4560 SOUTH BLVD | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234521160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574903223 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 03/10/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 3068 | TN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 0119004522 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.