Individual
DELBERT DEWAYNE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
787 CRUTCH CREEK LN, DUNGANNON, VA 24245-3950
(276) 467-1164
Mailing address
787 CRUTCH CREEK LN, DUNGANNON, VA 24245-3950
(276) 467-1164
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131000167
VA
Other
Enumeration date
01/02/2015
Last updated
01/02/2015
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