Healthcare Provider Details

I. General information

NPI: 1386508315
Provider Name (Legal Business Name): CAITLIN ELIZABETH CANNON OTR/L, OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WILKES RIDGE DR
RICHMOND VA
23233-7632
US

IV. Provider business mailing address

2307 BUENA VISTA BLVD
CHESTER VA
23831-2218
US

V. Phone/Fax

Practice location:
  • Phone: 804-877-4000
  • Fax:
Mailing address:
  • Phone: 631-605-2449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119010010
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: