Provider Demographics
NPI:1992176804
Name:SUNRAY OCCUPATIONAL THERAPY SERVICEES LLC
Entity type:Organization
Organization Name:SUNRAY OCCUPATIONAL THERAPY SERVICEES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ADMINISTRATOR/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MALGORZATA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRZYBOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MABS OTR/L
Authorized Official - Phone:571-228-4210
Mailing Address - Street 1:5701 EVERGREEN KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-1056
Mailing Address - Country:US
Mailing Address - Phone:571-228-4210
Mailing Address - Fax:
Practice Address - Street 1:5701 EVERGREEN KNOLL CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-1056
Practice Address - Country:US
Practice Address - Phone:571-228-4210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-18
Last Update Date:2015-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002418225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty