Provider Demographics
NPI:1598221913
Name:FAHHAM, GRACE G (OTR/L)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:G
Last Name:FAHHAM
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 1:41922 BERYL TER
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-2906
Mailing Address - Country:US
Mailing Address - Phone:703-589-2030
Mailing Address - Fax:
Practice Address - Street 1:10701 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6995
Practice Address - Country:US
Practice Address - Phone:703-273-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist