Healthcare Provider Details

I. General information

NPI: 1164114005
Provider Name (Legal Business Name): COLLEEN ALEXANDRA GORR MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN ALEXANDRA COLVILLE MS OTR/L

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7116 FORT HUNT RD
ALEXANDRIA VA
22307-1900
US

IV. Provider business mailing address

106 N UNION ST
ALEXANDRIA VA
22314-3244
US

V. Phone/Fax

Practice location:
  • Phone: 484-340-2146
  • Fax:
Mailing address:
  • Phone: 484-340-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: