Provider Demographics
NPI:1417261223
Name:HOUSEHOLDER, STEVEN BRADLEY (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:BRADLEY
Last Name:HOUSEHOLDER
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 1:2631 BRAMBLETON AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-4305
Mailing Address - Country:US
Mailing Address - Phone:540-774-3485
Mailing Address - Fax:
Practice Address - Street 1:2631 BRAMBLETON AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-4305
Practice Address - Country:US
Practice Address - Phone:540-774-3485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000419224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant