Provider Demographics
NPI:1275876476
Name:PETERS, TERRY ANTOINETTE (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:TERRY
Middle Name:ANTOINETTE
Last Name:PETERS
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 1:46 DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:NORTH DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23803-7495
Mailing Address - Country:US
Mailing Address - Phone:804-861-0259
Mailing Address - Fax:
Practice Address - Street 1:46 DIAMOND DR
Practice Address - Street 2:
Practice Address - City:NORTH DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23803-7495
Practice Address - Country:US
Practice Address - Phone:804-861-0259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA224Z00000X-OTA224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0131000136OtherOTA LICENSE