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General NPI Number Information
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NPI Number | 1447481478
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Entity Type | Organization
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Legal Business Name | CHESTERFIELD OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 08/08/2009
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 9006 CANVASBACK CIR
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City | CHESTERFIELD
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State | VA
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Zip | 23838-5275
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Country | US
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Telephone | 804-748-0428
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Fax |
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Provider Business Mailing Address
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Address Line | 9006 CANVASBACK CIR
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City | CHESTERFIELD
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State | VA
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Zip | 23838-5275
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Country | US
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Telephone | 804-748-0428
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. ANDREA KOREN ENGLERT
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Credential | OTR/L
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Telephone | 804-748-0428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119001293
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 1255386
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License Number State | VA
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