Provider Demographics
NPI:1154894327
Name:PECHAITIS, CYNTHIA W (COTA/L)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:W
Last Name:PECHAITIS
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 1:9760 BIG BETHEL CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-9388
Mailing Address - Country:US
Mailing Address - Phone:540-645-0541
Mailing Address - Fax:
Practice Address - Street 1:12100 CHANCELLORS VILLAGE LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6100
Practice Address - Country:US
Practice Address - Phone:540-786-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001562224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant