Provider Demographics
NPI:1114137981
Name:SIEGEL, AMY ANDERSON (OTRL)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:ANDERSON
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:REBECCA
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:450 GARRISONVILLE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1532
Mailing Address - Country:US
Mailing Address - Phone:540-242-5216
Mailing Address - Fax:540-659-7447
Practice Address - Street 1:450 GARRISONVILLE RD STE 102
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554
Practice Address - Country:US
Practice Address - Phone:540-242-5216
Practice Address - Fax:540-659-7447
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004421225XH1200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics