Provider Demographics
NPI:1063243806
Name:VILLADA, NATASHA (OTR/L)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:VILLADA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 K ST NW UNIT 1103
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-5272
Mailing Address - Country:US
Mailing Address - Phone:609-402-5833
Mailing Address - Fax:
Practice Address - Street 1:111 O ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1144
Practice Address - Country:US
Practice Address - Phone:202-518-3928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT210002344225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist