Provider Demographics
NPI:1265866883
Name:REDFORD, KATHLEEN H (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:H
Last Name:REDFORD
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 1:2728 LEWISTON PLANK RD
Mailing Address - Street 2:
Mailing Address - City:BURKEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23922-2417
Mailing Address - Country:US
Mailing Address - Phone:434-767-1220
Mailing Address - Fax:
Practice Address - Street 1:2003 COBB ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2603
Practice Address - Country:US
Practice Address - Phone:434-392-6106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000376224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant