Provider Demographics
NPI:1326154071
Name:WOOLDRIDGE, SALLY MINNICH (OT)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:MINNICH
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11712 JEFFERSON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4406
Mailing Address - Country:US
Mailing Address - Phone:757-595-4880
Mailing Address - Fax:757-595-4886
Practice Address - Street 1:11712 JEFFERSON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4406
Practice Address - Country:US
Practice Address - Phone:757-595-4880
Practice Address - Fax:757-595-4886
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000085225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010029171Medicaid
VA4651840001Medicare NSC
VA00V150P73Medicare PIN