Provider Demographics
NPI:1497205371
Name:STURGIS, AVA CAROLE
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:CAROLE
Last Name:STURGIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 WALNEY ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151
Mailing Address - Country:US
Mailing Address - Phone:703-466-5533
Mailing Address - Fax:703-466-5316
Practice Address - Street 1:4530 WALNEY ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151
Practice Address - Country:US
Practice Address - Phone:703-466-5533
Practice Address - Fax:703-466-5316
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119 007061225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist