Healthcare Provider Details

I. General information

NPI: 1104768993
Provider Name (Legal Business Name): KATELEN GARRAGHTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 GABLES DR STE 101
FOREST VA
24551-4996
US

IV. Provider business mailing address

2212 CENTERVILLE RD
BEDFORD VA
24523-4208
US

V. Phone/Fax

Practice location:
  • Phone: 804-508-6499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: