Provider Demographics
NPI:1336308766
Name:CROSS, WANDA ANNETTE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:ANNETTE
Last Name:CROSS
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 1:696 CARYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4959
Mailing Address - Country:US
Mailing Address - Phone:757-875-1791
Mailing Address - Fax:
Practice Address - Street 1:305 MARCELLA RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2433
Practice Address - Country:US
Practice Address - Phone:757-825-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000255224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant