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General NPI Number Information
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NPI Number | 1508024068
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Entity Type | Individual
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Provider Name | AUDREY PHILATRE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 205 S WHITING ST STE 200
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City | ALEXANDRIA
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State | VA
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Zip | 22304-3693
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Country | US
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Telephone | 781-654-5267
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 STEVENSON AVE APT 907
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City | ALEXANDRIA
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State | VA
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Zip | 22304-3573
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Country | US
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Telephone |
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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 | 0119004921
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License Number State | VA
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