Provider Demographics
NPI:1508660523
Name:LACKS, BRITTANY KALEA (COTA/L)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:KALEA
Last Name:LACKS
Suffix:
Gender:
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3118 MORTONS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:NATHALIE
Mailing Address - State:VA
Mailing Address - Zip Code:24577-3056
Mailing Address - Country:US
Mailing Address - Phone:434-471-3759
Mailing Address - Fax:
Practice Address - Street 1:184 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23927-9010
Practice Address - Country:US
Practice Address - Phone:434-206-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant