Provider Demographics
NPI:1053409110
Name:DIVER-LAVER, DENISE (OT)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:DIVER-LAVER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:DIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:800 SHAHRAAM CT SE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5972
Mailing Address - Country:US
Mailing Address - Phone:703-255-2339
Mailing Address - Fax:
Practice Address - Street 1:407 CHURCH ST NE
Practice Address - Street 2:SUITE G
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4737
Practice Address - Country:US
Practice Address - Phone:703-255-2339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000586225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist