Provider Demographics
NPI:1386306496
Name:WEBSTER, CYNTHIA (OT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CLIFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-2710
Mailing Address - Country:US
Mailing Address - Phone:703-201-8155
Mailing Address - Fax:
Practice Address - Street 1:401 CLIFFORD AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-2710
Practice Address - Country:US
Practice Address - Phone:703-201-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist