Individual
SAMANTHA HERRELL BAGNATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
2235 TACKETTS MILL DR # C, WOODBRIDGE, VA 22192-3036
(703) 491-1044
Mailing address
7315 MENDOTA AVE, FALLS CHURCH, VA 22042-1413
(540) 533-7006
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119008524
VA
225XP0200X
Pediatric Occupational Therapist
0119008524
VA
Other
Enumeration date
03/03/2021
Last updated
01/11/2022
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