| Lauren E Illencik, ORT/L | |
|
5301 Providence Rd Ste 80and90, Virginia Beach, VA 23464-4128 | |
| (757) 467-4604 | |
| (757) 467-2716 |
| Full Name | Lauren E Illencik |
|---|---|
| Gender | Female |
| Speciality | Occupational Therapist |
| Location | 5301 Providence Rd Ste 80and90, Virginia Beach, Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366021354 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225X00000X | Occupational Therapist | 0119008159 (Virginia) | Primary |
| 225X00000X | Occupational Therapist | 009314 (Arizona) | Secondary |
| Provider Name | Northern Arizona Healthcare Corporation |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1669914552 PECOS PAC ID: 3577473362 Enrollment ID: O20170801003409 |
| Mailing Address | Practice Location Address |
|---|---|
| Lauren E Illencik, ORT/L 1377 Motor Pkwy Ste 307, Islandia, NY 11749-5258 Ph: (914) 294-4050 | Lauren E Illencik, ORT/L 5301 Providence Rd Ste 80and90, Virginia Beach, VA 23464-4128 Ph: (757) 467-4604 |
Ms. Evelyn Zirkle, OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 1400 Fordham Dr, Virginia Beach, VA 23464 Phone: 757-361-3954 | |
Ms. Kelley Teresa Yates, M.S. OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 5301 Providence Rd, Suite 80, Virginia Beach, VA 23464 Phone: 757-467-4604 Fax: 757-467-2716 | |
Mrs. Melissa Ann Stapleford, OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 5301 Providence Rd, Suite 80, Virginia Beach, VA 23464 Phone: 757-467-4604 Fax: 757-467-2716 | |
Brooke Danielle Coley, OTR/L Occupational Therapist Medicare: Medicare Enrolled Practice Location: 5604 Virginia Beach Blvd, Virginia Beach, VA 23462 Phone: 757-455-5000 | |
Ms. Andrea Marie Mackie, OT Occupational Therapist Medicare: Accepting Medicare Assignments Practice Location: 1800 Camelot Dr, Suite 300, Virginia Beach, VA 23454 Phone: 757-321-4284 Fax: 757-321-4287 | |
Kaleigh Polys, OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 5604 Virginia Beach Blvd Ste 101, Virginia Beach, VA 23462 Phone: 757-455-5000 | |
Ms. Clary M Jones, OT Occupational Therapist Medicare: Medicare Enrolled Practice Location: 818 Newtown Rd, Virginia Beach, VA 23462 Phone: 757-261-4475 |