Healthcare Provider Details

I. General information

NPI: 1033703327
Provider Name (Legal Business Name): CHRISTIAN TAYLOR STALLINGS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTIAN TAYLOR DIFRUSCIO OTR/L

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10124 W BROAD ST STE P
GLEN ALLEN VA
23060-3330
US

IV. Provider business mailing address

7364 RIVER PINE DR
MECHANICSVILLE VA
23111-5243
US

V. Phone/Fax

Practice location:
  • Phone: 804-273-6656
  • Fax:
Mailing address:
  • Phone: 804-517-1154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119008255
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: