1841470606 NPI number — OPEQUON REHABILITATION & WELLNESS, PC

Table of content: AMANDA MEREDITH KASICA MS CCCSLP (NPI 1568665214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841470606 NPI number — OPEQUON REHABILITATION & WELLNESS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEQUON REHABILITATION & WELLNESS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841470606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3107 VALLEY AVE
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-2675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-535-2228
Provider Business Mailing Address Fax Number:
540-535-2204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3107 VALLEY AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22601-2675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-535-2228
Provider Business Practice Location Address Fax Number:
540-535-2204
Provider Enumeration Date:
11/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SIMS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
SHELBY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
540-535-2228

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  2305003951 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C10395 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com