Healthcare Provider Details

I. General information

NPI: 1982995874
Provider Name (Legal Business Name): AMY NICOLE FEHR MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001A LOISDALE RD
SPRINGFIELD VA
22150-1904
US

IV. Provider business mailing address

10185 EVESHAM LN
FAIRFAX VA
22030-4416
US

V. Phone/Fax

Practice location:
  • Phone: 703-971-0602
  • Fax: 703-971-0606
Mailing address:
  • Phone: 314-435-1270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119005352
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: