Provider Demographics
NPI:1750683819
Name:STEPHENS, CATHERINE CRANE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:CRANE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 LITTLE CREEK RD
Mailing Address - Street 2:APARTMENT 100
Mailing Address - City:RINGGOLD
Mailing Address - State:VA
Mailing Address - Zip Code:24586-3100
Mailing Address - Country:US
Mailing Address - Phone:434-429-8211
Mailing Address - Fax:
Practice Address - Street 1:508 RISON ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2457
Practice Address - Country:US
Practice Address - Phone:434-799-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000787224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant