Provider Demographics
NPI:1548732688
Name:SAUL, AUDRA LYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:LYNN
Last Name:SAUL
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 1:2295 ROBERTSON RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-5488
Mailing Address - Country:US
Mailing Address - Phone:540-587-0581
Mailing Address - Fax:
Practice Address - Street 1:101 LEROY BOWEN DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5093
Practice Address - Country:US
Practice Address - Phone:434-239-6630
Practice Address - Fax:434-239-6640
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002061224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0131002061OtherBOARD OF MEDICINE