Provider Demographics
NPI:1083108278
Name:DISMAYA, CHARLENE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:DISMAYA
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 1:504 MCKINZIE CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3280
Mailing Address - Country:US
Mailing Address - Phone:757-513-8978
Mailing Address - Fax:
Practice Address - Street 1:2448 SHIPYARD RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-3905
Practice Address - Country:US
Practice Address - Phone:757-558-5356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005382225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics