Provider Demographics
NPI:1053554972
Name:SIGURDSON, AUDREY Z (MOT, OTR/L)
Entity type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:Z
Last Name:SIGURDSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2278 PIMMIT RUN LN
Mailing Address - Street 2:#1
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-2209
Mailing Address - Country:US
Mailing Address - Phone:703-867-5691
Mailing Address - Fax:
Practice Address - Street 1:3302 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3353
Practice Address - Country:US
Practice Address - Phone:703-645-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003749225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist