Individual
TERESA MAE WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
881 BIFROST WAY, LINDEN, VA 22642-5931
(480) 291-2380
Mailing address
881 BIFROST WAY, LINDEN, VA 22642-5931
(480) 291-2380
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131000537
VA
Other
Enumeration date
05/14/2012
Last updated
05/14/2012
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