Individual
CARLY NICOLE BUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
21750 RED RUM DR STE 117, ASHBURN, VA 20147-5867
(703) 574-2989
(703) 574-2941
Mailing address
12065 GREYWING SQ APT B1, RESTON, VA 20191-1866
(571) 253-1842
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131002880
VA
Other
Enumeration date
04/03/2025
Last updated
04/03/2025
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