Healthcare Provider Details

I. General information

NPI: 1013625474
Provider Name (Legal Business Name): BERNARD JAMES GAMIAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY
RESTON VA
20190-3204
US

IV. Provider business mailing address

9004 PRINCE WILLIAM ST APT 310
MANASSAS VA
20110-5086
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119009134
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: