Provider Demographics
NPI:1740709898
Name:PHILLIPS, DENISE M (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:M
Last Name:PHILLIPS
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 1:6704 MERRIDITH LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1783
Mailing Address - Country:US
Mailing Address - Phone:540-548-1568
Mailing Address - Fax:
Practice Address - Street 1:3020 GORDON W SHELTON BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5010
Practice Address - Country:US
Practice Address - Phone:540-370-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-10
Last Update Date:2017-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000833224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant