Healthcare Provider Details

I. General information

NPI: 1366297913
Provider Name (Legal Business Name): DANIELLE BUBB OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12581 MILSTEAD WAY STE 302
WOODBRIDGE VA
22192-5446
US

IV. Provider business mailing address

7206 KINGS ARM DR
MANASSAS VA
20112-3236
US

V. Phone/Fax

Practice location:
  • Phone: 703-239-7336
  • Fax:
Mailing address:
  • Phone: 571-332-7712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119010371
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: