Provider Demographics
NPI:1912783739
Name:HART, AUTUMN (OTR/L)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ARCHERY LANE
Mailing Address - Street 2:
Mailing Address - City:ELK CREEK
Mailing Address - State:VA
Mailing Address - Zip Code:24326
Mailing Address - Country:US
Mailing Address - Phone:276-768-8631
Mailing Address - Fax:
Practice Address - Street 1:34 ARCHERY LANE
Practice Address - Street 2:
Practice Address - City:ELK CREEK
Practice Address - State:VA
Practice Address - Zip Code:24326
Practice Address - Country:US
Practice Address - Phone:276-768-8631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119009847225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist