Healthcare Provider Details

I. General information

NPI: 1881988251
Provider Name (Legal Business Name): DORA LUZ COAKLEY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15560 COSBY VILLAGE AVE APT 316
CHESTERFIELD VA
23832-2149
US

IV. Provider business mailing address

15560 COSBY VILLAGE AVE APT 316
CHESTERFIELD VA
23832-2149
US

V. Phone/Fax

Practice location:
  • Phone: 917-742-7509
  • Fax:
Mailing address:
  • Phone: 917-742-7509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119009627
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: