Individual
KIM NECZYPORUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1912 MEMORIAL AVE, LYNCHBURG, VA 24501-1708
(434) 845-8765
(434) 845-8467
Mailing address
1912 MEMORIAL AVE, LYNCHBURG, VA 24501-1708
(434) 845-8765
(434) 845-8467
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131001063
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396706065
—
VA
01
—
1811020597
ANTHEM
VA
Enumeration date
04/08/2014
Last updated
04/08/2014
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