Provider Demographics
NPI:1508129776
Name:KASEY COTTERMAN
Entity Type:Organization
Organization Name:KASEY COTTERMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:COTTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:567-204-7962
Mailing Address - Street 1:5561 FOREST HILL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-2551
Mailing Address - Country:US
Mailing Address - Phone:567-204-7962
Mailing Address - Fax:
Practice Address - Street 1:8830 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:AMELIA COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23002-4826
Practice Address - Country:US
Practice Address - Phone:804-561-5611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA9314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility