Healthcare Provider Details

I. General information

NPI: 1083549679
Provider Name (Legal Business Name): WAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 3RD ST S
ARLINGTON VA
22204-1714
US

IV. Provider business mailing address

PSC 473 BOX 2713
FPO AP
96349-0028
US

V. Phone/Fax

Practice location:
  • Phone: 850-668-8905
  • Fax:
Mailing address:
  • Phone: 80-412-9250
  • 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: DANIELLE BRIANNA GUTIERREZ
Title or Position: CEO
Credential: OT
Phone: 80-412-9250