Provider Demographics
NPI:1760931927
Name:RYAN, MAUDE MAE (COTA-L)
Entity Type:Individual
Prefix:MRS
First Name:MAUDE
Middle Name:MAE
Last Name:RYAN
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 1:1317 BARBARA CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-2707
Mailing Address - Country:US
Mailing Address - Phone:757-593-8823
Mailing Address - Fax:
Practice Address - Street 1:1317 BARBARA CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-2707
Practice Address - Country:US
Practice Address - Phone:757-593-8823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001631224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant