Provider Demographics
NPI:1255505343
Name:HENDERSON, AMY RATCLIFF (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:RATCLIFF
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 FOREST HILL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-3241
Mailing Address - Country:US
Mailing Address - Phone:804-231-0231
Mailing Address - Fax:804-232-4215
Practice Address - Street 1:4403 FOREST HILL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-3241
Practice Address - Country:US
Practice Address - Phone:804-231-0231
Practice Address - Fax:804-232-4215
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002051225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist