Provider Demographics
NPI:1811412299
Name:RICHMOND, LILLIAN CONNER (COTA/L)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:CONNER
Last Name:RICHMOND
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 1:1746 ROY CHEEK RD
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24263-8197
Mailing Address - Country:US
Mailing Address - Phone:276-219-7926
Mailing Address - Fax:
Practice Address - Street 1:2801 US HIGHWAY 25 E STE 98
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2075
Practice Address - Country:US
Practice Address - Phone:606-302-4388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001830224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant