Provider Demographics
NPI:1558978882
Name:DURANTE, ADRIENNE N (COTA/L)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:N
Last Name:DURANTE
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 1:10503 RISING RIDGE RD APT 401
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-8203
Mailing Address - Country:US
Mailing Address - Phone:516-660-2252
Mailing Address - Fax:
Practice Address - Street 1:1936 OPITZ BLVD STE A
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3360
Practice Address - Country:US
Practice Address - Phone:516-660-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002332224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant