Provider Demographics
NPI:1942765987
Name:WILLIAMS, CORETTA EASLEY (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:CORETTA
Middle Name:EASLEY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:CORETTA
Other - Middle Name:DOMINQUE
Other - Last Name:EASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1033 E OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:VA
Mailing Address - Zip Code:24558-3025
Mailing Address - Country:US
Mailing Address - Phone:434-579-9390
Mailing Address - Fax:
Practice Address - Street 1:625 PINEY FOREST RD STE 407
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2870
Practice Address - Country:US
Practice Address - Phone:434-799-7732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001952224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant