Provider Demographics
NPI:1104228444
Name:LEWIS, VICTORIA (OTR/L)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:BOSSHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1828 BELLAMY PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-8002
Mailing Address - Country:US
Mailing Address - Phone:860-707-3734
Mailing Address - Fax:
Practice Address - Street 1:1610 FOREST AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5009
Practice Address - Country:US
Practice Address - Phone:804-282-4596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006259225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics