=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841863578
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHELSEY LYNN MARIE WILLIAMS COTA/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2021
-----------------------------------------------------
Last Update Date | 07/20/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1807 N PARHAM RD
-----------------------------------------------------
City | HENRICO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-4020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-477-3148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9701 CANDACE CT UNIT 1
-----------------------------------------------------
City | GLEN ALLEN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23060-3713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-432-4586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | 0131002430
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------