Provider Demographics
NPI:1952637407
Name:FARRISH, TONIA JEAN (COTA)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:JEAN
Last Name:FARRISH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 MARS DR
Mailing Address - Street 2:
Mailing Address - City:AXTON
Mailing Address - State:VA
Mailing Address - Zip Code:24054-3571
Mailing Address - Country:US
Mailing Address - Phone:276-229-9404
Mailing Address - Fax:
Practice Address - Street 1:85 MARS DR
Practice Address - Street 2:
Practice Address - City:AXTON
Practice Address - State:VA
Practice Address - Zip Code:24054-3571
Practice Address - Country:US
Practice Address - Phone:276-229-9404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000516224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant