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General NPI Number Information
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NPI Number | 1669561437
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Entity Type | Individual
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Provider Name | NANCY FARMER BROCKWAY OT/L
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3750 OLD LEE HWY INFANT TODDLER CONNECTION
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City | FAIRFAX
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State | VA
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Zip | 22030-1806
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Country | US
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Telephone | 703-246-7164
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Fax |
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Provider Business Mailing Address
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Address Line | 8994 HOME GUARD DR
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City | BURKE
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State | VA
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Zip | 22015-2189
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Country | US
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Telephone | 703-323-0063
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 0119000140
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License Number State | VA
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