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NPI Code Detail

MEDICARE: KATHLEEN FARRIS MS OTR/L

MEDICARE: KATHLEEN FARRIS MS OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist0119006040VA

General Provider Information

NPI Number : 1710173232
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN FARRIS MS OTR/L
Provider Business Mailing Address
First Line : 1602 BELLE VIEW BLVD # 3189
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22307-6531
Country : US
Telephone Number : 314-458-6313
Fax Number :
Provider Business Practice Location Address
First Line : 1602 BELLE VIEW BLVD # 3189
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22307-6531
Country : US
Telephone Number : 716-969-5469
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2007
Last Update Date : 03/05/2019

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