Active NPI
Domonique Gholson, MS OTR/L
- Occupational Therapist
- Ashland, VA
National Provider Identifier
1104528835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 0119009849
- Practice address
- 100 England St
Ashland, VA 23005-2013 - Phone
- (804) 368-8475
- NPI assigned
- Mar 20, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Early Intervention Provider Agency
- Ashland, VA
- NPI 1033516992
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0119009849 | VA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allied Instructional Services | Past | Accepting new patients |
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 | 0119009849 | VA | Primary |
Addresses
Primary practice location
100 England St
Ashland, VA 23005-2013
Mailing address
8319 Marwood Drive
North Chesterfield, VA 23235
Phone (804) 687-0308
NPI Registry JSON
{
"created_epoch": "1679270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723334400000",
"number": "1104528835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8319 MARWOOD DRIVE",
"city": "NORTH CHESTERFIELD",
"state": "VA",
"postal_code": "23235",
"telephone_number": "804-687-0308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 ENGLAND ST",
"city": "ASHLAND",
"state": "VA",
"postal_code": "230052013",
"telephone_number": "804-368-8475"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHOLSON",
"first_name": "DOMONIQUE",
"credential": "MS OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-20",
"last_updated": "2024-08-11",
"certification_date": "2024-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "VA",
"license": "0119009849",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ashland, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.