Provider Demographics
NPI:1629645775
Name:DRIGGERS, ERIC LEE
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LEE
Last Name:DRIGGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 BRANTLEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4020
Mailing Address - Country:US
Mailing Address - Phone:804-218-9635
Mailing Address - Fax:
Practice Address - Street 1:908 BRANTLEY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4020
Practice Address - Country:US
Practice Address - Phone:804-218-9635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006584225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAJ655OtherPRIVATE PRACTICE