Healthcare Provider Details

I. General information

NPI: 1528346798
Provider Name (Legal Business Name): SARA E PRITT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001A LOISDALE RD
SPRINGFIELD VA
22150-1904
US

IV. Provider business mailing address

7001A LOISDALE RD
SPRINGFIELD VA
22150-1904
US

V. Phone/Fax

Practice location:
  • Phone: 703-971-0602
  • Fax: 703-971-0606
Mailing address:
  • Phone: 703-971-0602
  • Fax: 703-971-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119005298
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT010000643
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: