Provider Demographics
NPI:1104187335
Name:OTI, COLETTE OGECHI
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:OGECHI
Last Name:OTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14302 CANDLEWICK CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2540
Mailing Address - Country:US
Mailing Address - Phone:804-839-1101
Mailing Address - Fax:
Practice Address - Street 1:14302 CANDLEWICK CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2540
Practice Address - Country:US
Practice Address - Phone:804-839-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005641225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist