Basic Information
| Provider Information | |||||||||
| NPI: | 1457086589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARROU | ||||||||
| FirstName: | KATRINA | ||||||||
| MiddleName: | ALESE | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1419 OAK KNOLL CT | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234647949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083432808 | ||||||||
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| Practice Location | |||||||||
| Address1: | 107 E 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238511719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7577763088 | ||||||||
| FaxNumber: | 7576124499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2022 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 0131002714 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.