Provider Demographics
NPI:1730696659
Name:REILLY, LORETTA H (COTA)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:H
Last Name:REILLY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 TORINGTON DR UNIT M
Mailing Address - Street 2:
Mailing Address - City:W SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1084
Mailing Address - Country:US
Mailing Address - Phone:561-306-9208
Mailing Address - Fax:
Practice Address - Street 1:2100 POWHATAN ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-1940
Practice Address - Country:US
Practice Address - Phone:703-538-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-30
Last Update Date:2017-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001930224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant