Provider Demographics
NPI:1679845119
Name:FRASER, ROSMOND VILMA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ROSMOND
Middle Name:VILMA
Last Name:FRASER
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 1:3518 MEADOW OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-4886
Mailing Address - Country:US
Mailing Address - Phone:804-271-4634
Mailing Address - Fax:804-271-4634
Practice Address - Street 1:3518 MEADOW OAKS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-4886
Practice Address - Country:US
Practice Address - Phone:804-271-4634
Practice Address - Fax:804-271-4634
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000081224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant