Provider Demographics
NPI:1841494143
Name:KILLINGSWORTH, VIVIAN (COTA)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:KILLINGSWORTH
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 1:520 BERRY MOORE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24440-2024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 HILLSMERE LN
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-1796
Practice Address - Country:US
Practice Address - Phone:540-885-9500
Practice Address - Fax:540-885-3422
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1030920224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant