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General NPI Number Information
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NPI Number | 1184219677
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Entity Type | Individual
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Provider Name | ASHLEY NICOLE DESTEFANO MOT OTR
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Gender | Female
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 7112 BRADDOCK RD
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City | ANNANDALE
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State | VA
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Zip | 22003-6007
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Country | US
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Telephone | 703-256-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 137 JASPER PL
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City | ALEXANDRIA
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State | VA
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Zip | 22304-4905
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Country | US
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Telephone | 740-632-8774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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