Healthcare Provider Details

I. General information

NPI: 1790547321
Provider Name (Legal Business Name): KATHARYN ELIZABETH MARTIN BCABA, COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7617 LITTLE RIVER TPKE STE 100
ANNANDALE VA
22003-2603
US

IV. Provider business mailing address

8241 OLD HAGERSTOWN RD
MIDDLETOWN MD
21769-8826
US

V. Phone/Fax

Practice location:
  • Phone: 703-639-0950
  • Fax:
Mailing address:
  • Phone: 717-891-6754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133005209
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: