Healthcare Provider Details

I. General information

NPI: 1225627870
Provider Name (Legal Business Name): MCKENZIE LEANN RYCHCIK COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14115 LOVERS LN
CULPEPER VA
22701-4157
US

IV. Provider business mailing address

14851 PORTERFIELD DR APT 7
ORANGE VA
22960-1261
US

V. Phone/Fax

Practice location:
  • Phone: 540-225-1150
  • Fax: 540-595-3482
Mailing address:
  • Phone: 540-222-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131-002439
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: