NPIMap

Individual provider Active NPI

Teresa Ann Herdegen, MS OTR/L

  • Pediatric Occupational Therapist
  • Woodbridge, VA
National Provider Identifier
1174078240
Registry record updated Aug 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
0119006188 Issued in VA
Practice address
2235 Tacketts Mill Dr
Suite C
Woodbridge, VA 22192-3036
Phone
(703) 491-1044
Fax
(703) 491-2044
NPI assigned
Aug 18, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X 0119006188 VA Primary

Addresses

Primary practice location

2235 Tacketts Mill Dr
Suite C
Woodbridge, VA 22192-3036

Mailing address

2235 Tacketts Mill Dr
Suite C
Woodbridge, VA 22192-3036
Phone (703) 491-1044

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
0119006188VAMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Achievements, LLC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471478400000",
    "number": "1174078240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2235 TACKETTS MILL DR",
            "address_2": "SUITE C",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221923036",
            "telephone_number": "703-491-1044",
            "fax_number": "703-491-2044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 TACKETTS MILL DR",
            "address_2": "SUITE C",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221923036",
            "telephone_number": "703-491-1044",
            "fax_number": "703-491-2044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERDEGEN",
        "first_name": "TERESA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "MS OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-18",
        "last_updated": "2016-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "VA",
            "license": "0119006188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.