Provider Demographics
NPI:1083187322
Name:VALDEZ, ANNETTE (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11555 OLDE TIVERTON CIR APT 35-201
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1913
Mailing Address - Country:US
Mailing Address - Phone:562-253-7351
Mailing Address - Fax:
Practice Address - Street 1:2445 ARMY NAVY DR STE 304
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2905
Practice Address - Country:US
Practice Address - Phone:562-253-7351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131-002120224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty