Provider Demographics
NPI:1235465543
Name:SHERLOCK, VANESSA (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:VANESSA
Middle Name:
Last Name:SHERLOCK
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:PO BOX 2062
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:VA
Mailing Address - Zip Code:23692-2062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5702 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:VA
Practice Address - Zip Code:23692-2878
Practice Address - Country:US
Practice Address - Phone:345-678-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2017-09-27
Deactivation Date:2012-01-24
Deactivation Code:
Reactivation Date:2017-09-27
Provider Licenses
StateLicense IDTaxonomies
VA0131000248224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant