Healthcare Provider Details

I. General information

NPI: 1679932883
Provider Name (Legal Business Name): TAMMY ANN MERRIMAN OTL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 MAIN ST
FAIRFAX VA
22030-6904
US

IV. Provider business mailing address

28 WESTMORELAND DR
STERLING VA
20165-7900
US

V. Phone/Fax

Practice location:
  • Phone: 703-273-7705
  • Fax:
Mailing address:
  • Phone: 908-337-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119006781
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: