Healthcare Provider Details

I. General information

NPI: 1275177438
Provider Name (Legal Business Name): ANNIE RACHEL POOLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 COLUMBIA PIKE SUITE 125
ARLINGTON VA
22204
US

IV. Provider business mailing address

1301 PENNSYLVANIA AVE SE
WASHINGTON DC
20003-3027
US

V. Phone/Fax

Practice location:
  • Phone: 571-527-0818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119008388
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT010001683
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: