Provider Demographics
NPI:1952972945
Name:LONDON, SALLY ANN (OT)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:LONDON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 LAWFORD DR SW
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-5083
Mailing Address - Country:US
Mailing Address - Phone:703-380-7807
Mailing Address - Fax:
Practice Address - Street 1:601 CATOCTIN CIR NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4964
Practice Address - Country:US
Practice Address - Phone:703-777-1939
Practice Address - Fax:703-777-1935
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003679225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty