Healthcare Provider Details

I. General information

NPI: 1952044083
Provider Name (Legal Business Name): DEGANN CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 TURKEY RUN RD
MC LEAN VA
22101-1708
US

IV. Provider business mailing address

1017 TURKEY RUN RD
MC LEAN VA
22101-1708
US

V. Phone/Fax

Practice location:
  • Phone: 917-842-5455
  • Fax:
Mailing address:
  • Phone: 917-842-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ALEXANDER DANIEL DEGANN
Title or Position: OWNER
Credential: OTR/L, CHT, MB
Phone: 917-842-5455