Provider Demographics
NPI:1114121068
Name:PATTERSON, PERETHA FAYE (COTA)
Entity Type:Individual
Prefix:
First Name:PERETHA
Middle Name:FAYE
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SAINT WILLIAMS WAY
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-3640
Mailing Address - Country:US
Mailing Address - Phone:540-287-8002
Mailing Address - Fax:
Practice Address - Street 1:15 SAINT WILLIAMS WAY
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-3640
Practice Address - Country:US
Practice Address - Phone:540-287-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0131000208OtherCOMMONWEALTH OF VIRGINIA, DEPARTMENT OF HEALTH PROFESSIONS, LICENSE