Individual
TARA FASANELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
12628 FAIR CREST CT, FAIRFAX, VA 22033-3888
(724) 664-4521
Mailing address
12628 FAIR CREST CT, FAIRFAX, VA 22033-3888
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131000874
VA
Other
Enumeration date
01/05/2015
Last updated
01/05/2015
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