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General NPI Number Information
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NPI Number | 1194659631
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Entity Type | Organization
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Legal Business Name | FAIRY THERAPETUIC PLLC
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Dates
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Enumeration Date | 06/10/2026
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Last Update Date | 06/10/2026
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Provider Practice Location Address
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Address Line | 6884 PIEDMONT CENTER PLZ
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City | GAINESVILLE
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State | VA
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Zip | 20155-4035
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Country | US
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Telephone | 571-284-7612
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31
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City | BEALETON
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State | VA
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Zip | 22712-0031
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Country | US
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Telephone | 540-571-1880
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Fax |
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Authorized Official
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Title or Position | RELAXATIONAL THERAIPST
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Name | KASSI MOORE
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Credential |
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Telephone | 540-571-1880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WM1400X
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Taxonomy Name | Nurse Massage Therapist (NMT)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 173C00000X
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Taxonomy Name | Reflexologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #6
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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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Taxonomy #7
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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