Healthcare Provider Details

I. General information

NPI: 1740116599
Provider Name (Legal Business Name): GOLDEN WEAVER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 BLENHEIM BLVD STE 21C
FAIRFAX VA
22030-2432
US

IV. Provider business mailing address

3915 BLENHEIM BLVD STE 21C
FAIRFAX VA
22030-2432
US

V. Phone/Fax

Practice location:
  • Phone: 571-307-4248
  • Fax:
Mailing address:
  • Phone: 571-307-4248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KAYLA SHARMA
Title or Position: OWNER PROVIDER AUTHORIZED OFFICIAL
Credential: O.T.
Phone: 571-307-4248