Healthcare Provider Details

I. General information

NPI: 1033503776
Provider Name (Legal Business Name): DOTS4PEDSLLC-DEVELOPMENTAL OUTPATIENT THERAPY SERVICES FOR PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 06/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8208 SMITHFIELD AVE
SPRINGFIELD VA
22152-3053
US

IV. Provider business mailing address

8208 SMITHFIELD AVE
SPRINGFIELD VA
22152-3053
US

V. Phone/Fax

Practice location:
  • Phone: 703-451-0452
  • Fax:
Mailing address:
  • Phone: 703-451-0452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number00119001236
License Number StateVA

VIII. Authorized Official

Name: MRS. JODIE ANN CALLAHAN
Title or Position: OCCUPATIONAL THERAPIST/CO-FOUNDER
Credential: OTR
Phone: 703-451-0452