Provider Demographics
NPI:1972012151
Name:MONIZ, EIBLISH TOBIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:EIBLISH
Middle Name:TOBIN
Last Name:MONIZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:EIBLISH
Other - Middle Name:J
Other - Last Name:TOBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1102 ROSE HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-5128
Mailing Address - Country:US
Mailing Address - Phone:434-979-8628
Mailing Address - Fax:434-979-8536
Practice Address - Street 1:1102 ROSE HILL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5128
Practice Address - Country:US
Practice Address - Phone:434-979-8628
Practice Address - Fax:434-979-8536
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004551225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119004551OtherSTATE LICENSE