Provider Demographics
NPI:1811562531
Name:MIFFLIN, TRE'EISHA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:TRE'EISHA
Middle Name:
Last Name:MIFFLIN
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 1:108 FRIENDLY DR APT E
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23605-1212
Mailing Address - Country:US
Mailing Address - Phone:302-393-1542
Mailing Address - Fax:
Practice Address - Street 1:1401 HALSTEAD AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2003
Practice Address - Country:US
Practice Address - Phone:757-857-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119009031225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119009031OtherSTATE LICENSURE