Healthcare Provider Details

I. General information

NPI: 1417955014
Provider Name (Legal Business Name): CHRISTINA CARR OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA CALLAHAN

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 WALNEY ROAD SUITE 203
CHANTILLY VA
20151
US

IV. Provider business mailing address

4530 WALNEY ROAD SUITE 203
CHANTILLY VA
20151
US

V. Phone/Fax

Practice location:
  • Phone: 703-466-5533
  • Fax:
Mailing address:
  • Phone: 703-466-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119004057
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: