Provider Demographics
NPI:1154746337
Name:DAWN, SHANDA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:SHANDA
Middle Name:
Last Name:DAWN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 STEEDS GRANT WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-1401
Mailing Address - Country:US
Mailing Address - Phone:301-526-5814
Mailing Address - Fax:
Practice Address - Street 1:5695 KING CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5745
Practice Address - Country:US
Practice Address - Phone:571-303-1298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119009526225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics