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General NPI Number Information
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NPI Number | 1811412299
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Entity Type | Individual
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Provider Name | LILLIAN CONNER RICHMOND COTA/L
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Gender | Female
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Dates
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Enumeration Date | 08/07/2017
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Last Update Date | 08/07/2017
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Provider Practice Location Address
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Address Line | 2801 US HIGHWAY 25 E STE 98
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City | MIDDLESBORO
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State | KY
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Zip | 40965-2075
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Country | US
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Telephone | 606-302-4388
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Fax |
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Provider Business Mailing Address
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Address Line | 1746 ROY CHEEK RD
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City | JONESVILLE
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State | VA
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Zip | 24263-8197
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Country | US
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Telephone | 276-219-7926
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Fax |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 0131001830
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License Number State | VA
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