Healthcare Provider Details

I. General information

NPI: 1104156223
Provider Name (Legal Business Name): AMY CATHERINE CULLEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 09/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 POTOMAC AVE SE
WASHINGTON DC
20003-4115
US

IV. Provider business mailing address

1235 POTOMAC AVE SE
WASHINGTON DC
20003-4115
US

V. Phone/Fax

Practice location:
  • Phone: 703-309-7732
  • Fax:
Mailing address:
  • Phone: 703-309-7732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT010000561
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119004658
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: