Individual
SAMANTHA KRISTINA THEDIECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1900 LAUDERDALE DR, RICHMOND, VA 23238-3933
(804) 740-2900
Mailing address
6243 MIDNIGHT DR, MECHANICSVILLE, VA 23111-6566
(804) 380-0598
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131002655
VA
Other
Enumeration date
07/16/2025
Last updated
07/16/2025
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