Healthcare Provider Details

I. General information

NPI: 1477872539
Provider Name (Legal Business Name): MARY A PETRIE MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 LEESVILLE RD
LYNCHBURG VA
24502-2828
US

IV. Provider business mailing address

3300 RIVERMONT AVE
LYNCHBURG VA
24503-2030
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5750
  • Fax:
Mailing address:
  • Phone: 434-200-5032
  • Fax: 434-200-1294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119005118
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: