Healthcare Provider Details

I. General information

NPI: 1821983727
Provider Name (Legal Business Name): ALLIE WARD OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 BRANDON AVE STE 130
SPRINGFIELD VA
22150-2519
US

IV. Provider business mailing address

6225 BRANDON AVE STE 130
SPRINGFIELD VA
22150-2519
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119011027
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: