Healthcare Provider Details

I. General information

NPI: 1831672310
Provider Name (Legal Business Name): MARTHA HENNESSEY DEALE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 MACARTHUR BLVD NW
WASHINGTON DC
20016-2541
US

IV. Provider business mailing address

5901 MACARTHUR BLVD NW
WASHINGTON DC
20016-2541
US

V. Phone/Fax

Practice location:
  • Phone: 301-922-3025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT6
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: