Provider Demographics
NPI:1598422933
Name:PAYNE, JEREMY (COTA)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 LUNA LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-7144
Mailing Address - Country:US
Mailing Address - Phone:434-250-4056
Mailing Address - Fax:
Practice Address - Street 1:101 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3700
Practice Address - Country:US
Practice Address - Phone:276-352-4465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant