Provider Demographics
NPI:1326377060
Name:MORENO, ERIN D (OT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:D
Last Name:MORENO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9900 MAIN ST
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3907
Mailing Address - Country:US
Mailing Address - Phone:703-279-4249
Mailing Address - Fax:703-279-4271
Practice Address - Street 1:6355 WALKER LN
Practice Address - Street 2:SUITE 512
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3245
Practice Address - Country:US
Practice Address - Phone:703-971-3701
Practice Address - Fax:301-856-0964
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2012-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0119004097225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
244618YZWMedicare PIN