Provider Demographics
NPI:1174965453
Name:O'REILLY, VIRGINIA M (OTR/L)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:M
Last Name:O'REILLY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 4TH ST N
Mailing Address - Street 2:APT 4108
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-2740
Mailing Address - Country:US
Mailing Address - Phone:347-265-7871
Mailing Address - Fax:
Practice Address - Street 1:11601 4TH ST N
Practice Address - Street 2:APT 4108
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-2740
Practice Address - Country:US
Practice Address - Phone:347-265-7871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018163225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist