=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669840252
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ART ARM REHABILITATION THERAPIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2015
-----------------------------------------------------
Last Update Date | 09/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9033 BLARNEY STONE DR
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22152-2130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-969-3634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9033 BLARNEY STONE DR
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22152-2130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-969-3634
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER & PRESIDENT
-----------------------------------------------------
Name | MR. RAHSAAN JAMAL HOLLEY
-----------------------------------------------------
Credential | MS, OTR
-----------------------------------------------------
Telephone | 703-969-3634
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 0119003283
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------