Active NPI
Alexis Whiteside
- Occupational Therapist
- Suffolk, VA
National Provider Identifier
1023641644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 0119008860
- Practice address
- 100 Anna Goode Way
Suffolk, VA 23434-9236 - Phone
- (757) 923-5500
- NPI assigned
- Feb 21, 2020
- Reactivated
- Feb 9, 2021
- Last updated
- Feb 10, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 0119008860 | VA | Primary |
Addresses
Primary practice location
100 Anna Goode Way
Suffolk, VA 23434-9236
Mailing address
131 S Thalia Rd
Virginia Beach, VA 23452-1230
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0119008860 | VA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612915200000",
"number": "1023641644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "131 S THALIA RD",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234521230"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 ANNA GOODE WAY",
"city": "SUFFOLK",
"state": "VA",
"postal_code": "234349236",
"telephone_number": "757-923-5500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITESIDE",
"first_name": "ALEXIS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-21",
"last_updated": "2021-02-10",
"certification_date": "2021-02-10",
"deactivation_date": "2021-01-20",
"reactivation_date": "2021-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "VA",
"license": "0119008860",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suffolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.