Provider Demographics
NPI:1649405762
Name:KING STUART, ALYSON ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:ANN
Last Name:KING STUART
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 1:10471 LABRADOR LOOP
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-2734
Mailing Address - Country:US
Mailing Address - Phone:703-304-8810
Mailing Address - Fax:703-331-1354
Practice Address - Street 1:8341 BARRETT DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-3594
Practice Address - Country:US
Practice Address - Phone:703-257-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000906225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist