Provider Demographics
NPI:1700561768
Name:BRASHEAR, CARLY RHEA (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:RHEA
Last Name:BRASHEAR
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 1:313 E MONROE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-1600
Mailing Address - Country:US
Mailing Address - Phone:571-547-8507
Mailing Address - Fax:
Practice Address - Street 1:2620 MAIN LINE BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301-3081
Practice Address - Country:US
Practice Address - Phone:571-577-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119009810225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist