Healthcare Provider Details

I. General information

NPI: 1609904341
Provider Name (Legal Business Name): THERAPY 4 KIDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 10/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9685 MAIN ST STE B
FAIRFAX VA
22031-3752
US

IV. Provider business mailing address

9685 MAIN ST STE B
FAIRFAX VA
22031-3752
US

V. Phone/Fax

Practice location:
  • Phone: 703-978-8400
  • Fax: 703-978-9898
Mailing address:
  • Phone: 703-978-8400
  • Fax: 703-978-9898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119002945
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202003923
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305202398
License Number StateVA

VIII. Authorized Official

Name: MRS. LORNA SHER
Title or Position: VICE PRESIDENT
Credential: OT
Phone: 703-978-8400