Provider Demographics
NPI:1679221857
Name:FOGARTY, ALETHA NORA (COTA)
Entity Type:Individual
Prefix:
First Name:ALETHA
Middle Name:NORA
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-1804
Mailing Address - Country:US
Mailing Address - Phone:804-938-2856
Mailing Address - Fax:
Practice Address - Street 1:1250 BRANCHLANDS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1703
Practice Address - Country:US
Practice Address - Phone:434-973-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002646224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant