Provider Demographics
NPI:1245449875
Name:CROGHAN, BETH (OT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:CROGHAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 MOONSHADOW LN
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:VA
Mailing Address - Zip Code:23093-4921
Mailing Address - Country:US
Mailing Address - Phone:540-967-2339
Mailing Address - Fax:
Practice Address - Street 1:10401 SPOTSYLVANIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-8606
Practice Address - Country:US
Practice Address - Phone:540-741-3770
Practice Address - Fax:540-741-3775
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA001052225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand