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NPI Code Detail

MEDICARE: TELISHA KELLY ROBERTS COTA/L

MEDICARE: TELISHA KELLY ROBERTS COTA/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant0131000076VA
2225700000XMassage Therapist0019009488VA

General Provider Information

NPI Number : 1316170384
Entity Type Code : Individual
Provider Name (Legal Business Name) : TELISHA KELLY ROBERTS COTA/L
Provider Business Mailing Address
First Line : 1 PARK WEST CIR STE 108
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-5552
Country : US
Telephone Number : 804-419-1536
Fax Number :
Provider Business Practice Location Address
First Line : 12001 IRON BRIDGE RD
Second Line :
City : CHESTER
State : VA
Zip : 23831-1460
Country : US
Telephone Number : 804-706-1023
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2009
Last Update Date : 01/17/2025

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