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General NPI Number Information
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NPI Number | 1477872539
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Entity Type | Individual
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Provider Name | MARY A PETRIE MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 693 LEESVILLE RD
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City | LYNCHBURG
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State | VA
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Zip | 24502-2828
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Country | US
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Telephone | 434-200-5750
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 RIVERMONT AVE
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City | LYNCHBURG
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State | VA
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Zip | 24503-2030
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Country | US
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Telephone | 434-200-5032
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Fax | 434-200-1294
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0119005118
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License Number State | VA
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