Individual
MRS. HEATHER MARIE TAVARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR L
Contact information
Practice address
6506 LOISDALE RD, STE 300, SPRINGFIELD, VA 22150
(703) 924-4100
(703) 922-0638
Mailing address
25893 DONOVAN DR, CHANTILLY, VA 20152
(703) 957-4268
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119003116
VA
225X00000X
Occupational Therapist
OT010000316
DC
Other
Enumeration date
12/06/2005
Last updated
02/20/2012
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