Healthcare Provider Details

I. General information

NPI: 1619274685
Provider Name (Legal Business Name): EARLY START THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6416 GROVEDALE DR STE 300
ALEXANDRIA VA
22310-2678
US

IV. Provider business mailing address

2445 ARMY NAVY DR SUITE 305
ARLINGTON VA
22206-2905
US

V. Phone/Fax

Practice location:
  • Phone: 703-813-6330
  • Fax: 301-710-6379
Mailing address:
  • Phone: 703-813-6330
  • Fax: 301-710-6379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH BOLANLE AKINYELE
Title or Position: CEO
Credential:
Phone: 301-254-0782