Provider Demographics
NPI:1396638953
Name:ABEBE, EDOM (OTR)
Entity type:Individual
Prefix:
First Name:EDOM
Middle Name:
Last Name:ABEBE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7507 ASHBY LN UNIT I
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5214
Mailing Address - Country:US
Mailing Address - Phone:325-374-6484
Mailing Address - Fax:
Practice Address - Street 1:1768 BUSINESS CENTER DR STE 330
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4882
Practice Address - Country:US
Practice Address - Phone:703-679-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119010931225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist