Healthcare Provider Details

I. General information

NPI: 1164622619
Provider Name (Legal Business Name): HOLLI D CHILDRESS COF, CFO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 DABNEY RD SUITE C
RICHMOND VA
23230-3361
US

IV. Provider business mailing address

2034 DABNEY RD SUITE C
RICHMOND VA
23230-3361
US

V. Phone/Fax

Practice location:
  • Phone: 804-649-9043
  • Fax: 804-783-8212
Mailing address:
  • Phone: 804-649-9043
  • Fax: 804-783-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC26328
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: