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General NPI Number Information
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NPI Number | 1518371657
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Entity Type | Organization
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Legal Business Name | WINGS TO FLY THERAPY AND PLAY CENTER
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 4530 WALNEY ROAD SUITE 203
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City | CHANTILLY
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State | VA
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Zip | 20151
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Country | US
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Telephone | 703-466-5533
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Fax | 703-466-5533
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Provider Business Mailing Address
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Address Line | 4530 WALNEY ROAD SUITE 203
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City | CHANTILLY
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State | VA
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Zip | 20151
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Country | US
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Telephone | 703-466-5533
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Fax | 703-466-5533
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | DONNA SHANK
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Credential | M.A.
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Telephone | 703-466-5533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | VA
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