Healthcare Provider Details

I. General information

NPI: 1598684144
Provider Name (Legal Business Name): LILA MARIE SHIPLEY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LAFAYETTE CENTER DR STE 103
CHANTILLY VA
20151-1234
US

IV. Provider business mailing address

4100 LAFAYETTE CENTER DR STE 103
CHANTILLY VA
20151-1234
US

V. Phone/Fax

Practice location:
  • Phone: 571-297-0000
  • Fax:
Mailing address:
  • Phone: 571-297-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119011444
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: