Healthcare Provider Details

I. General information

NPI: 1174509830
Provider Name (Legal Business Name): JULIE A BRODY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE A INNERST OT

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14348 GIDEON DR
WOODBRIDGE VA
22192-4640
US

IV. Provider business mailing address

14348 GIDEON DR
WOODBRIDGE VA
22192-4640
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-1112
  • Fax: 703-878-8732
Mailing address:
  • Phone: 703-490-1112
  • Fax: 703-878-8732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number0119001308
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: