Provider Demographics
NPI:1891125548
Name:HEAVEY-SWINGLE, VIVIAN (OT/L)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:HEAVEY-SWINGLE
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 ATTLEBORO DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-2713
Mailing Address - Country:US
Mailing Address - Phone:703-455-0191
Mailing Address - Fax:
Practice Address - Street 1:8270 WILLOW OAKS CORPORATE DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4511
Practice Address - Country:US
Practice Address - Phone:703-509-7236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-16
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002086225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist