Healthcare Provider Details

I. General information

NPI: 1871475962
Provider Name (Legal Business Name): CHANDLER TYRRELL ROEGGE MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANDLER ANNE TYRRELL MSOT, OTR/L

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 HAMAKER CT STE 100
FAIRFAX VA
22031-2233
US

IV. Provider business mailing address

3020 HAMAKER CT STE 100
FAIRFAX VA
22031-2233
US

V. Phone/Fax

Practice location:
  • Phone: 703-844-8599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number0119007262
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: