Provider Demographics
NPI:1396264529
Name:FLICK, PATRICIA ANN (COTA/L)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:FLICK
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 1:3243 ELECTRIC RD BLDG E
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6440
Mailing Address - Country:US
Mailing Address - Phone:540-404-1189
Mailing Address - Fax:
Practice Address - Street 1:3243 ELECTRIC RD BLDG E
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6440
Practice Address - Country:US
Practice Address - Phone:540-404-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001879224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant