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General NPI Number Information
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NPI Number | 1346925542
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Entity Type | Individual
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Provider Name | COLIN NULTY OT
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Gender | Male
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Dates
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Enumeration Date | 06/16/2023
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 3998 FAIR RIDGE DR STE 100-B
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City | FAIRFAX
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State | VA
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Zip | 22033-2907
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Country | US
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Telephone | 703-934-0333
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Fax |
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Provider Business Mailing Address
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Address Line | 1318 ALDBURY WAY
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City | RESTON
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State | VA
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Zip | 20194-1428
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Country | US
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Telephone | 703-509-4470
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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 | 0119009956
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License Number State | VA
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