Healthcare Provider Details

I. General information

NPI: 1023866159
Provider Name (Legal Business Name): KELLIE SAWYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

5984 KIMBERLY ANNE WAY UNIT 301
ALEXANDRIA VA
22310-5478
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-3690
  • Fax:
Mailing address:
  • Phone: 919-593-3634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7849
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119005317
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT210002203
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: