Provider Demographics
NPI:1346433117
Name:BLACK, CINDY (OTR/L)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:BLACK
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 1:2604 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-5011
Mailing Address - Country:US
Mailing Address - Phone:540-657-1423
Mailing Address - Fax:540-657-1424
Practice Address - Street 1:2604 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-5011
Practice Address - Country:US
Practice Address - Phone:540-657-1423
Practice Address - Fax:540-657-1424
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004445225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics