Healthcare Provider Details

I. General information

NPI: 1508129776
Provider Name (Legal Business Name): KASEY COTTERMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8830 VIRGINIA ST
AMELIA COURT HOUSE VA
23002-4826
US

IV. Provider business mailing address

5561 FOREST HILL AVE
RICHMOND VA
23225-2551
US

V. Phone/Fax

Practice location:
  • Phone: 804-561-5611
  • Fax:
Mailing address:
  • Phone: 567-204-7962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number9
License Number StateVA

VIII. Authorized Official

Name: MS. KASEY KRISTINE COTTERMAN
Title or Position: OCCUPATIONAL THERAPIST ASSISTANT
Credential: COTA/L
Phone: 567-204-7962