Healthcare Provider Details

I. General information

NPI: 1326208935
Provider Name (Legal Business Name): SURABHI RAO OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1742
US

IV. Provider business mailing address

9900 MAIN ST SUITE 200A
FAIRFAX VA
22031-3907
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-1026
  • Fax: 703-391-1027
Mailing address:
  • Phone: 703-279-4249
  • Fax: 703-279-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119003570
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: