Healthcare Provider Details

I. General information

NPI: 1487952446
Provider Name (Legal Business Name): PRADNYA VISHNU OZARDE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13350 FRANKLIN FARM RD STE 200
HERNDON VA
20171-4095
US

IV. Provider business mailing address

PO BOX 715868
PHILADELPHIA PA
19171-5868
US

V. Phone/Fax

Practice location:
  • Phone: 703-810-5204
  • Fax: 703-810-5411
Mailing address:
  • Phone: 804-915-1910
  • Fax: 804-968-1803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119009172
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: