Provider Demographics
NPI:1184119067
Name:DADE, VIVIAN YVETTE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:YVETTE
Last Name:DADE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 LONGWORTHE SQ
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-1225
Mailing Address - Country:US
Mailing Address - Phone:703-619-0988
Mailing Address - Fax:
Practice Address - Street 1:8000 ILIFF DR
Practice Address - Street 2:
Practice Address - City:DUNN LORING
Practice Address - State:VA
Practice Address - Zip Code:22027-1235
Practice Address - Country:US
Practice Address - Phone:703-560-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001734224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty