Provider Demographics
NPI:1487012787
Name:STEVENS, ASHLEIGH BALSAMO (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEIGH
Middle Name:BALSAMO
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:MS
Other - First Name:ASHLEIGH
Other - Middle Name:LAUREN
Other - Last Name:BALSAMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:3900 JERMANTOWN RD
Mailing Address - Street 2:#150
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4900
Mailing Address - Country:US
Mailing Address - Phone:703-910-5006
Mailing Address - Fax:
Practice Address - Street 1:3900 JERMANTOWN RD
Practice Address - Street 2:#150
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4900
Practice Address - Country:US
Practice Address - Phone:703-910-5006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005067225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist