Provider Demographics
NPI:1558240390
Name:BOMAR, JOSHUA SCOTT (OTR/L)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:SCOTT
Last Name:BOMAR
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 GABLES DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4996
Mailing Address - Country:US
Mailing Address - Phone:804-508-6499
Mailing Address - Fax:
Practice Address - Street 1:1040 GABLES DR STE 101
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-4996
Practice Address - Country:US
Practice Address - Phone:804-508-6499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
VA0119011115225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist