Individual
BRENDA PHOEUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
14348 GIDEON DR, WOODBRIDGE, VA 22192-4640
(703) 490-1112
Mailing address
14348 GIDEON DR, WOODBRIDGE, VA 22192-4640
(703) 490-1112
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119009455
VA
Other
Enumeration date
06/07/2022
Last updated
06/14/2022
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