Individual
MISS TERRY ANTOINETTE PETERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
46 DIAMOND DR, NORTH DINWIDDIE, VA 23803-7495
(804) 861-0259
Mailing address
46 DIAMOND DR, NORTH DINWIDDIE, VA 23803-7495
(804) 861-0259
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
224Z00000X-OTA
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0131000136
OTA LICENSE
VA
Enumeration date
04/05/2013
Last updated
04/05/2013
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