Healthcare Provider Details

I. General information

NPI: 1780214627
Provider Name (Legal Business Name): BRITTANY LOWE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19471 MCCRAY DR
ABINGDON VA
24211-6837
US

IV. Provider business mailing address

19471 MCCRAY DR
ABINGDON VA
24211-6837
US

V. Phone/Fax

Practice location:
  • Phone: 276-492-6717
  • Fax:
Mailing address:
  • Phone: 276-492-6717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6436
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: