MEDICARE: INTERNATIONAL DIAGNOSTIC SOLUTIONS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist
4	103TB0200X	Cognitive & Behavioral Psychologist

General Provider Information

NPI Number	:	1912397001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL DIAGNOSTIC SOLUTIONS

Provider Business Mailing Address
First Line	:	641 S ST NW FL 3
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20001-5196
Country	:	US
Telephone Number	:	202-262-6537
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 S ST NW
Second Line	:	THIRD FLOOR
City	:	WASHINGTON
State	:	DC
Zip	:	20001-5131
Country	:	US
Telephone Number	:	202-643-7462
Fax Number	:

Authorized Official
Title or Position	:	COFOUNDER
Name	:	MS. TRACEY ELLIS
Credential	:	OTR/L, MPH
Telephone Number	:	202-202-6537

Provider Enumeration Date	:	01/28/2015
Last Update Date	:	11/26/2019

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Directions to “INTERNATIONAL DIAGNOSTIC SOLUTIONS ” Practice Location

Language	Start Address	Practice Location

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