Provider Demographics
NPI:1447481478
Name:CHESTERFIELD OCCUPATIONAL THERAPY
Entity type:Organization
Organization Name:CHESTERFIELD OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:KOREN
Authorized Official - Last Name:ENGLERT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:804-748-0428
Mailing Address - Street 1:9006 CANVASBACK CIR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-5275
Mailing Address - Country:US
Mailing Address - Phone:804-748-0428
Mailing Address - Fax:
Practice Address - Street 1:9006 CANVASBACK CIR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23838-5275
Practice Address - Country:US
Practice Address - Phone:804-748-0428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-08
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001293225X00000X
VA1255386252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty