Organization Active NPI

Seaside Occupational Therapy, LLC

  • Occupational Therapist
  • Hampton, VA
National Provider Identifier
1457995540
Registry record updated Nov 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
SEASIDE OCCUPATIONAL THERAPY, LLC
Practice address
2200 Executive Dr Ste E
Hampton, VA 23666-2582
Phone
(757) 655-1130
NPI assigned
Oct 31, 2019
Last updated
Nov 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amanda Harrison, MS, OTR/LNPI 1225445794
Title
Occupational Therapist
Phone
(757) 655-1130

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

2200 Executive Dr Ste E
Hampton, VA 23666-2582

Mailing address

2200 Executive Dr Ste E
Hampton, VA 23666-2582
Phone (757) 655-1130

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200122001173 VA Part B Supplier - Clinic/Group Practice 8426483439 Receives reassigned benefits from 1 practitioner
Practice locations: Hampton, VA

National Provider Directory

National Provider Directory

Locations

12 W Queens Way
Hampton, VA 23669
Phone (757) 655-1130

5 W Queens Way
Ste 102
Hampton, VA 23669
Phone (757) 655-1130

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732838400000",
    "number": "1457995540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 EXECUTIVE DR STE E",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236662582",
            "telephone_number": "757-655-1130",
            "fax_number": "757-702-5811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 EXECUTIVE DR STE E",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236662582",
            "telephone_number": "757-655-1130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEASIDE OCCUPATIONAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-31",
        "last_updated": "2024-11-29",
        "certification_date": "2024-11-29",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "757-655-1130",
        "authorized_official_credential": "MS, OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hampton, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.