Provider Demographics
NPI:1295178416
Name:RICHARDSON, JAMES DAVID (COTA/L)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:RICHARDSON
Suffix:
Gender:M
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 1:438 23RD ST
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-2830
Mailing Address - Country:US
Mailing Address - Phone:304-465-1574
Mailing Address - Fax:304-465-8094
Practice Address - Street 1:438 23RD ST
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2830
Practice Address - Country:US
Practice Address - Phone:304-465-1574
Practice Address - Fax:304-465-8094
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1687224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant