Healthcare Provider Details

I. General information

NPI: 1689285413
Provider Name (Legal Business Name): MARIE MACTIGUE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date: 12/29/2025
Reactivation Date: 01/07/2026

III. Provider practice location address

6251 OLD DOMINION DR
MC LEAN VA
22101-4827
US

IV. Provider business mailing address

15405 CARROLTON RD
ROCKVILLE MD
20853-1704
US

V. Phone/Fax

Practice location:
  • Phone: 301-787-2233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number16177
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberU1-0012689
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: