Healthcare Provider Details

I. General information

NPI: 1295195139
Provider Name (Legal Business Name): CARA WEATHERFORD PAYNE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARA NELLL WEATHERFORD OTR/L

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 EXECUTIVE DR SUITE A
DANVILLE VA
24541
US

IV. Provider business mailing address

159 EXECUTIVE DR SUITE A
DANVILLE VA
24541
US

V. Phone/Fax

Practice location:
  • Phone: 434-799-7732
  • Fax: 866-468-5040
Mailing address:
  • Phone: 434-799-7732
  • Fax: 866-468-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119006889
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: