Provider Demographics
NPI:1972627206
Name:MCLEAN, ELISABETH GRANT (MS, OTR-L)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:GRANT
Last Name:MCLEAN
Suffix:
Gender:
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 1:2527 OAKHAMPTON PL
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2704
Mailing Address - Country:US
Mailing Address - Phone:619-796-3765
Mailing Address - Fax:
Practice Address - Street 1:14901 BOGLE DR STE 100
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1736
Practice Address - Country:US
Practice Address - Phone:571-346-3781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119008317225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist