Basic Information
| Provider Information | |||||||||
| NPI: | 1053680785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELTREN | ||||||||
| FirstName: | ANDRE | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2990 TELESTAR CT | ||||||||
| Address2: | SUITE 3PT | ||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220421207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5714235700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2280 OPITZ BLVD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221913362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035805160 | ||||||||
| FaxNumber: | 7035806880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2011 | ||||||||
| LastUpdateDate: | 12/27/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0119004335 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.