Provider Demographics
NPI:1033754429
Name:POMY, STEPHANIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:POMY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8609 SUDLEY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4500
Mailing Address - Country:US
Mailing Address - Phone:703-366-3626
Mailing Address - Fax:
Practice Address - Street 1:8609 SUDLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4500
Practice Address - Country:US
Practice Address - Phone:703-366-3626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-09
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119008136225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist