Healthcare Provider Details

I. General information

NPI: 1104605849
Provider Name (Legal Business Name): IMONI SAAB OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21631 RIDGETOP CIR
STERLING VA
20166-6742
US

IV. Provider business mailing address

4917 SAMMY JOE DR
FAIRFAX VA
22030-8274
US

V. Phone/Fax

Practice location:
  • Phone: 571-207-8850
  • Fax: 571-210-4934
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number15048
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15048
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number15048
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0119010692
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119010692
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: