Healthcare Provider Details

I. General information

NPI: 1760306120
Provider Name (Legal Business Name): BRAINS THAT BEWONDER OCCUPATIONAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 GENESEE PL STE 209
LAKE RIDGE VA
22192-8305
US

IV. Provider business mailing address

15061 GALAPAGOS PL
WOODBRIDGE VA
22193-5842
US

V. Phone/Fax

Practice location:
  • Phone: 703-987-5148
  • Fax:
Mailing address:
  • Phone: 703-987-5148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: TARYN NICHELLE PETTIGREW
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 703-987-5148