Provider Demographics
NPI:1376000521
Name:HENDERSON, DAVID NEALS (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:NEALS
Last Name:HENDERSON
Suffix:
Gender:M
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 1:300 PELL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-1182
Mailing Address - Country:US
Mailing Address - Phone:540-484-1456
Mailing Address - Fax:540-484-1236
Practice Address - Street 1:300 PELL AVE STE B
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1182
Practice Address - Country:US
Practice Address - Phone:540-484-1456
Practice Address - Fax:540-484-1236
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119008022225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist