Provider Demographics
NPI:1174139497
Name:OCCUPATIONAL TRANSITIONS, LLC
Entity type:Organization
Organization Name:OCCUPATIONAL TRANSITIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LA' SHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:401-326-4739
Mailing Address - Street 1:15 ELM ST
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 ELM ST
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1607
Practice Address - Country:US
Practice Address - Phone:401-326-4739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCCUPATIONAL TRANSITIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1962039131Medicaid