Healthcare Provider Details

I. General information

NPI: 1164677795
Provider Name (Legal Business Name): AILEEN MARIE MAPALO OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12475 ROUTE 50
FAIRFAX VA
22033-2803
US

IV. Provider business mailing address

12925 CENTRE PARK CIR APT 409
HERNDON VA
20171-5939
US

V. Phone/Fax

Practice location:
  • Phone: 703-352-7172
  • Fax:
Mailing address:
  • Phone: 571-212-5701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119004668
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT010000537
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: