Healthcare Provider Details

I. General information

NPI: 1295318434
Provider Name (Legal Business Name): TAYLOR ASHLEY HALTEMAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21630 RIDGETOP CIR STE 100
STERLING VA
20166-6564
US

IV. Provider business mailing address

12489 LUCAS DR
FAIRFAX VA
22033-4392
US

V. Phone/Fax

Practice location:
  • Phone: 571-449-6281
  • Fax:
Mailing address:
  • Phone: 610-850-5690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC017498
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119011479
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: