Provider Demographics
NPI:1851779136
Name:VALIENTE, MAXIM ELIZABETH (MOTR/L)
Entity Type:Individual
Prefix:
First Name:MAXIM
Middle Name:ELIZABETH
Last Name:VALIENTE
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2049 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7292
Mailing Address - Country:US
Mailing Address - Phone:540-657-1423
Mailing Address - Fax:
Practice Address - Street 1:2049 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7292
Practice Address - Country:US
Practice Address - Phone:540-657-1423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006622225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics