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General NPI Number Information
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NPI Number | 1376795922
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Entity Type | Organization
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Legal Business Name | LOW VISION THERAPY, LLC
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 1504 KINGSTREAM CIRCLE
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City | HERNDON
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State | VA
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Zip | 20170-2700
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Country | US
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Telephone | 703-505-5771
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Fax | 703-437-0168
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Provider Business Mailing Address
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Address Line | 1504 KINGSTREAM CIRCLE
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City | HERNDON
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State | VA
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Zip | 20170-2700
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Country | US
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Telephone | 703-505-5771
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Fax | 703-437-0168
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MRS. JOAN C. GILLARD
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Credential | OTR/L
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Telephone | 703-505-5771
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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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