Provider Demographics
NPI:1336867845
Name:NESSELRODT, DEVIN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DEVIN
Middle Name:
Last Name:NESSELRODT
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 1:307 N HOWARD ST APT 103
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2362
Mailing Address - Country:US
Mailing Address - Phone:540-820-1439
Mailing Address - Fax:
Practice Address - Street 1:5632 MOUNT VERNON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-1502
Practice Address - Country:US
Practice Address - Phone:703-766-8708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119008550225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist