Provider Demographics
NPI:1154553188
Name:RICKETTS, VALRIE V (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:VALRIE
Middle Name:V
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MRS
Other - First Name:VALRIE
Other - Middle Name:V
Other - Last Name:RICKETTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA/L
Mailing Address - Street 1:85 MISTY HILL DR
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:PA
Mailing Address - Zip Code:17314-7903
Mailing Address - Country:US
Mailing Address - Phone:443-226-0618
Mailing Address - Fax:717-456-5354
Practice Address - Street 1:85 MISTY HILL DR
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:PA
Practice Address - Zip Code:17314-7903
Practice Address - Country:US
Practice Address - Phone:443-226-0618
Practice Address - Fax:717-456-5354
Is Sole Proprietor?:No
Enumeration Date:2009-08-09
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00658224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant