Provider Demographics
NPI:1811302813
Name:WINN, CONNIE (COTA)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:WINN
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 1:4132 LONGHILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-6304
Mailing Address - Country:US
Mailing Address - Phone:757-645-4620
Mailing Address - Fax:757-645-4621
Practice Address - Street 1:4132 LONGHILL RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-6304
Practice Address - Country:US
Practice Address - Phone:757-645-4620
Practice Address - Fax:757-645-4621
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001281224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant