Provider Demographics
NPI:1114260841
Name:RICHARDSON, KAREN DENISE (COTA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DENISE
Last Name:RICHARDSON
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:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:SWORDS CREEK
Mailing Address - State:VA
Mailing Address - Zip Code:24649-0276
Mailing Address - Country:US
Mailing Address - Phone:276-873-4445
Mailing Address - Fax:
Practice Address - Street 1:101 MUSTANG DRIVE
Practice Address - Street 2:
Practice Address - City:SWORDS CREEK
Practice Address - State:VA
Practice Address - Zip Code:24649-0276
Practice Address - Country:US
Practice Address - Phone:276-873-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1072435224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant