Provider Demographics
NPI:1710563978
Name:MAXWELL, SIERRA N (MOT, ORT/L)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:N
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MOT, ORT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 JEFFERSON CT
Mailing Address - Street 2:
Mailing Address - City:ZION CROSSROADS
Mailing Address - State:VA
Mailing Address - Zip Code:22942-9602
Mailing Address - Country:US
Mailing Address - Phone:540-832-9012
Mailing Address - Fax:540-832-9013
Practice Address - Street 1:73 JEFFERSON CT
Practice Address - Street 2:
Practice Address - City:ZION CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22942-9602
Practice Address - Country:US
Practice Address - Phone:540-832-9012
Practice Address - Fax:540-832-9012
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119008951225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist