MEDICARE: ALEXANDER DANIEL DEGANN OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XH1200X	Hand Occupational Therapist	0119009259	VA

General Provider Information

NPI Number	:	1174928535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER DANIEL DEGANN OTR/L

Provider Business Mailing Address
First Line	:	1017 TURKEY RUN RD
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-1708
Country	:	US
Telephone Number	:	703-829-7151
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 TURKEY RUN RD
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-1708
Country	:	US
Telephone Number	:	703-829-7151
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2014
Last Update Date	:	04/10/2026

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