Provider Demographics
NPI:1053710749
Name:DURHAM, CASEY (COTA/L)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 TEXAS LN
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:VA
Mailing Address - Zip Code:24439-2517
Mailing Address - Country:US
Mailing Address - Phone:575-590-5870
Mailing Address - Fax:
Practice Address - Street 1:83 CROSSROADS LN
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:575-590-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001320224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant