1952611634 NPI number — MS. TAKEISHA MARIE VANCE OTR/L

Table of content: MS. TAKEISHA MARIE VANCE OTR/L (NPI 1952611634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952611634 NPI number — MS. TAKEISHA MARIE VANCE OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANCE
Provider First Name:
TAKEISHA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

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:
1952611634
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2425 18TH PLACE, SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20020-6315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-480-7390
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2425 18TH PLACE, SE
Provider Second Line Business Practice Location Address:
2411 32 ND ST, SE
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20020-6315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-575-5404
Provider Business Practice Location Address Fax Number:
301-576-5404
Provider Enumeration Date:
10/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT010000596 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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