Provider Demographics
NPI:1588239768
Name:CHU, KENNETH MING KIN (COTA)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MING KIN
Last Name:CHU
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Gender:M
Credentials:COTA
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Other - Credentials:
Mailing Address - Street 1:1722 LAWRENCEVILLE PLANK RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868-3351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1722 LAWRENCEVILLE PLANK RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868-3351
Practice Address - Country:US
Practice Address - Phone:434-848-4766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant