Provider Demographics
NPI:1013215763
Name:ROBERTS, VITA S (OT)
Entity Type:Individual
Prefix:
First Name:VITA
Middle Name:S
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:VITA
Other - Middle Name:S
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1309 KEMPSVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502
Mailing Address - Country:US
Mailing Address - Phone:757-461-5001
Mailing Address - Fax:757-461-1909
Practice Address - Street 1:1309 KEMPSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502
Practice Address - Country:US
Practice Address - Phone:757-461-5001
Practice Address - Fax:757-461-1909
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7805225X00000X
VA0119006488225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist