Healthcare Provider Details

I. General information

NPI: 1578165932
Provider Name (Legal Business Name): ENABLING WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 03/05/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42020 VILLAGE CENTER PLAZA STE 120 PMB 1003
STONE RIDGE VA
20105
US

IV. Provider business mailing address

42020 VILLAGE CENTER PLAZA STE 120 PMB 1003
STONE RIDGE VA
20105
US

V. Phone/Fax

Practice location:
  • Phone: 571-206-1616
  • Fax: 571-934-4029
Mailing address:
  • Phone: 571-206-1616
  • Fax: 571-934-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SIERRA TAYLOR WOLF
Title or Position: OWNER
Credential: OTD, OTR/L
Phone: 850-374-1731