Provider Demographics
NPI:1174509830
Name:BRODY, JULIE A (OT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:BRODY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11240 WAPLES MILL RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6078
Mailing Address - Country:US
Mailing Address - Phone:703-255-2339
Mailing Address - Fax:703-255-2402
Practice Address - Street 1:6273 FRANCONIA RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2510
Practice Address - Country:US
Practice Address - Phone:703-719-9460
Practice Address - Fax:703-719-9461
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001308225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ20232Medicare UPIN
PA081333D1XMedicare ID - Type Unspecified