Provider Demographics
NPI:1043488794
Name:TUBB, RUTH GRANTHAM (OT)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:GRANTHAM
Last Name:TUBB
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:GRANTHAM
Other - Last Name:HOLLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:230 CLEARFIELD AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1832
Mailing Address - Country:US
Mailing Address - Phone:757-321-3300
Mailing Address - Fax:757-321-3332
Practice Address - Street 1:6387 CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502
Practice Address - Country:US
Practice Address - Phone:757-321-3300
Practice Address - Fax:757-321-3332
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001154225XH1200X
VA225XH1200X225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA016725V01Medicare PIN
VAC05501Medicare PIN