Healthcare Provider Details

I. General information

NPI: 1902649387
Provider Name (Legal Business Name): FAIRFAX PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10306 EATON PL STE 300
FAIRFAX VA
22030-2201
US

IV. Provider business mailing address

4078 WALNUT COVE CIR
FAIRFAX VA
22033-6233
US

V. Phone/Fax

Practice location:
  • Phone: 571-587-6244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: TSAI-PEI SHEN
Title or Position: OWNER
Credential:
Phone: 571-587-6244