Provider Demographics
NPI:1578116356
Name:MAYHEW, CHELSEY JARRETT (COTA/L)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:JARRETT
Last Name:MAYHEW
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:CHELSEY
Other - Middle Name:BROOKE
Other - Last Name:JARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 MILES RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24078-2463
Mailing Address - Country:US
Mailing Address - Phone:276-618-8153
Mailing Address - Fax:
Practice Address - Street 1:27018 LEE HWY
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7512
Practice Address - Country:US
Practice Address - Phone:276-525-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002178224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant