Provider Demographics
NPI:1114237815
Name:CALVERT, WILLINDA SUE (COTA/L)
Entity Type:Individual
Prefix:
First Name:WILLINDA
Middle Name:SUE
Last Name:CALVERT
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 1:4114 STATE ROUTE 348
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-9376
Mailing Address - Country:US
Mailing Address - Phone:937-544-3311
Mailing Address - Fax:937-544-8983
Practice Address - Street 1:731 KENTON STATION RD
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9619
Practice Address - Country:US
Practice Address - Phone:606-759-5510
Practice Address - Fax:606-759-5592
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA2992224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant