Provider Demographics
NPI:1750479945
Name:HESTER, KASEY AUDRA DYER (MASTER OF OCCUPATION)
Entity Type:Individual
Prefix:MRS
First Name:KASEY
Middle Name:AUDRA DYER
Last Name:HESTER
Suffix:
Gender:F
Credentials:MASTER OF OCCUPATION
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:AUDRA
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASTER OF OCCUPATION
Mailing Address - Street 1:4560 SOUTH BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1160
Mailing Address - Country:US
Mailing Address - Phone:757-490-3223
Mailing Address - Fax:
Practice Address - Street 1:4560 SOUTH BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1160
Practice Address - Country:US
Practice Address - Phone:757-490-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3068225X00000X
VA0119004522225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist